Unmet health needs of uninsured adults in the United States

Context In 1998, 33 million US adults aged 18 to 64 years lacked health ins urance. Determining the unmet health needs of this population may aid effor ts to improve access to care. Objective To compare nationally representative estimates of the unmet healt h needs of uninsured and insured adults, particularly among persons with ma jor health risks. Design and setting Random household telephone survey conducted in all 50 st ates and the District of Columbia through the Behavioral Risk Factor Survei llance System. Participants A total of 105 764 adults aged 18 to 64 years in 1997 and 1173 64 in 1998, classified as long-term (greater than or equal to 1 year) unins ured (9.7%), short-term (<1 year) uninsured (4.3 %), or insured (86.0%). Main Outcome Measures Adjusted proportions of participants who could not se e a physician when needed due to cost in the past year, had not had a routi ne checkup within 2 years, and had not received clinically indicated preven tive services, compared by insurance status. Results Long-term- and short-term-uninsured adults were more likely than in sured adults to report that they could not see a physician when needed due to cost (26.8%, 21.7%, and 8.2%, respectively), especially among those in p oor health (69.1 %, 51.9%, and 21.8%) or fair health (48.8%, 42.4%, and 15. 7%) (P<.001). Long-term-uninsured adults in general were much more likely t han short-term-uninsured and insured adults not to have had a routine check up in the last 2 years (42.8%, 22.3%, and 17.8%, respectively) and among sm okers, obese individuals, binge drinkers, and people with hypertension, ele vated cholesterol, diabetes, or human immunodeficiency virus risk factors ( P<.001), Deficits in cancer screening, cardiovascular risk reduction, and d iabetes care were most pronounced among long-term-uninsured adults. Conclusions In our study, long-term-uninsured adults reported much greater unmet health needs than insured adults. Providing insurance to improve acce ss to care for long-term-uninsured adults, particularly those with major he alth risks, could have substantial clinical benefits.