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Institute of Medicine: Lack of Insurance Can Mean Early Death

June 17, 2002

Uninsured, HIV-positive adults are less likely to receive newer antiretroviral therapy drug combinations, says a new report from the Institute of Medicine of the National Academy of Sciences. Even when such patients do receive newer drug therapies, they wait an average four months longer for treatment than patients with private insurance.

The report, "Care Without Coverage: Too Little, Too Late," IOM, 05.31.02, said that providing health insurance to HIV/AIDS patients significantly reduces death rates. Past studies have suggested that a regular source of care is significant in successfully treating HIV/AIDS.

An earlier report showed uninsured patients are significantly more likely to wait three months longer for care after being diagnosed with HIV compared with insured patients. Having any kind of insurance at all, the report said, reduces short-term deaths among those with HIV by 71 to 85 percent.

"Because we don't see many people dying in the streets in this country, we assume that the uninsured manage to get the care they need, but the evidence refutes that assumption," said Mary Sue Coleman, president of the Iowa Health System and University of Iowa in Iowa City. "The fact is that the quality and length of life are distinctly different for insured and uninsured populations."

Coleman said that adults without insurance are much less likely than adults with any kind of health insurance to receive the screening and preventive services recommended by the US Preventive Services Task Force. The uninsured have a 25 percent higher risk of premature death than adults with coverage, she noted. The uninsured are hospitalized less frequently and the in-hospital mortality rates for uninsured adults are higher.

For health insurance to be effective, the coverage must be acquired before the development of an advanced disease, the report noted. In addition, "increased insurance coverage across the US population would likely reduce some of the racial and ethnic disparities in the use of appropriate health care and may also reduce disparities in morbidity and mortality."

Coverage that includes a full range of preventive and screening services, prescription drugs and mental health services and enlists adequate providers is more likely to facilitate appropriate care than insurance without these benefits, according to the report.

Those people most likely to be without insurance are adults ages 18 to 34 years. Those age 65 or older are least likely to lack insurance because of Medicare. Federal and state policies targeted at uninsured children in the United States mean that group, although 10-million strong, is less likely to lack coverage. Women are more likely than men to have insurance, but their insurance status is less stable than men, since men tend to have employment-based coverage.

Two-thirds of the uninsured are members of families who earn less than twice the federal poverty income level. Even members of families with two full-time wage earners have almost a 1-in-10 chance of being uninsured.

Although non-Hispanic whites make up more than half of the uninsured population, minorities are at a higher risk for being uninsured because they lag behind in areas such as employment and income. Non-citizen immigrants account for fewer than one-fifth of the uninsured.

About 80 percent of people offered insurance through their employment choose to participate. Of those who decline, about a quarter remain uninsured. Many refuse coverage because of the costs. Workers with employer-subsidized health plans typically pay one-quarter to one-third of the total cost of their insurance premiums, in addition to deductibles, co-payments and other costs, which can reach up to 10 percent of annual income in low-income families.

The 16-person Institute of Medicine committee reviewed more than 130 research studies of health insurance from the past two decades. The committee examined the consequences of being uninsured for people suffering from cancer, diabetes, HIV/AIDS, heart and kidney disease, mental illness, traumatic injuries and heart attacks. It focused on the roughly 30 million working-age Americans without health insurance.

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Adapted from:
AIDS Policy & Law

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
See Also
More Research on HIV and U.S. Health Insurance