How many working-age adults report that they do not get needed medical care because of its cost?

In 2005, 37 percent of working-age adults reported one or more of four cost-related access problems, up from 29 percent in 2001. Those who were uninsured at the time of the survey or at some time during the past year were twice as likely to report unmet needs as continuously insured adults (59%–60% vs. 28% in 2005).

Why is this important?

Adequate and continuous health insurance coverage is important to ensure timely access to needed health care and good outcomes (IOM 2002). Health insurance premiums have increased substantially in recent years, making it more difficult for individuals to afford coverage (Gabel et al. 2005). Even among those who have health insurance, more than one of 10 are underinsured—meaning that their coverage exposes them to high out-of-pocket costs relative to their income (Schoen et al. 2005).

Findings

In an ongoing survey of working-age adults (ages 19–64 years), the proportion who lacked health insurance coverage (public or private) at some time during the year increased from 24 percent in 2001 to 28 percent in 2005 (Collins, Davis, Doty et al. 2006).

• The proportion who were uninsured at the time of the survey increased from 15 percent in 2001 to 18 percent in 2005. Another 9 percent reported being uninsured at some time in the past year in both 2001 and 2005.
• About one-half of low-income working-age adults were uninsured at some point during 2001 (49%) and 2005 (53%). The proportion without health insurance increased most among those with moderate incomes—from 28 percent in 2001 to 41 percent in 2005.

The proportion reporting any of four cost-related unmet needs for medical care increased from 29 percent in 2001 to 37 percent in 2005 overall. Unmet needs increased among both insured adults and uninsured adults. In 2005, those who were currently uninsured or uninsured at any time in the past year reported similar rates of unmet needs (59%–60%), which were more than double the rates reported by continuously insured adults (28%) (Collins, Davis, Doty et al. 2006). Specific rates of unmet needs reported by the currently uninsured in 2005 were:

• 2.4 times higher for not filling a prescription (43% v. 18%);
• 3.0 times higher for skipping a medical test, treatment, or follow-up recommended by a doctor (39% v. 13%);
• 3.3 times higher for not visiting a doctor or clinic for a medical problem (49% v. 15%); and
• 3.7 times higher for not seeing a specialist when the individual or their doctor thought it was needed (37% v. 10%).

Among those who had private insurance coverage all year long, more than four of 10 (44%) of those with high deductibles ($1,000 or more) reported one or more of these cost-related unmet needs, as compared with one-quarter (25%) of those with deductibles under $500 and less than one-third (31%) of those with deductibles of $500 to $999 (Collins, Kriss, Davis et al. 2006).

Implications

Lack of health insurance, gaps in coverage, and inadequate coverage are leading many Americans to forgo or delay needed health care, with potentially deleterious outcomes (IOM 2002). In 2005, for example, more than one-third (35%) of uninsured adults with a chronic condition went to the emergency department or were hospitalized because of their condition, about two times the rate among continuously insured individuals with chronic health problems (Collins, Davis, Doty et al. 2006). More than one-half of the uninsured are either not eligible for existing public coverage programs or cannot afford to purchase coverage without financial assistance (Dubay et al. 2006).

Improvement Ideas and Resources

The study authors concluded: "Real solutions that build on group forms of coverage already in place, including employer plans, Medicare, Medicaid, the State Children's Health Insurance Program, and state and federal employee benefits plans, [would] help to fill insurance gaps with meaningful, affordable coverage that helps link families and providers" (Collins, Davis, Doty et al. 2006).

Measure:

The denominators for the charts include community-dwelling adults ages 19–64 classified by income or insurance status. Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–$34,999, middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005, low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more. For insurance status, individuals were classified as insured continuously within the past 12 months, insured when surveyed but uninsured at some point within the past 12 months, or uninsured at the time of the survey (Collins, Davis, Doty et al. 2006).

For unmet needs, numerators are the subset of the denominator population who reported one of four (or, for summary rates, any of four) health care access problems within the past 12 months because of cost: did not fill a prescription; skipped a medical test, treatment, or follow-up recommended by a doctor; had a medical problem but did not visit a doctor or clinic; did not see a specialist when you or your doctor thought you needed one.

Limitations:

Self-reported health care use and unmet need is subject to potential recall bias and may differ from medical need as defined by a health professional.

Source:

Data were compiled by researchers at the Commonwealth Fund based on responses to the 2001, 2003, and 2005 Commonwealth Fund Biennial Health Insurance Survey, a nationally representative telephone survey of civilian, noninstitutionalized adults ages 19 and older (Collins, Davis, Doty et al. 2006; Collins, Kriss, Davis et al. 2006).

References:

* Indicates source of data used in the chart(s).

* Collins, S. R., K. Davis, M. M. Doty et al. 2006. Gaps in Health Insurance: An All-American Problem. New York: The Commonwealth Fund.

* Collins, S. R., J. L. Kriss, K. Davis et al. 2006. Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families. New York: The Commonwealth Fund.

Dubay, L., J. Holahan, and A. Cook. 2006. The Uninsured and the Affordability of Health Insurance Coverage. Health Affairs Web Exclusive: W22–W30.

Gabel, J., G. Claxton, I. Gil et al. 2005. Health Benefits in 2005: Premium Increases Slow Down, Coverage Continues to Erode. Health Affairs 24 (5): 1273–80.

IOM (Institute of Medicine). 2002. Care Without Coverage: Too Little, Too Late. Washington, D.C.: National Academies Press.

Schoen, C., M. M. Doty, S. R. Collins et al. 2005. Insured but Not Protected: How Many Adults Are Underinsured? Health Affairs Web Exclusives: W5-289–W5-302.