Effects of being uninsured on ethnic minorities' management of chronic illness

Objective To compare the effectiveness with which insured and uninsured per sons with chronic illnesses managed their health care. Design Recruited vol unteers diagnosed with a variety of chronic illnesses who underwent 3 semis tructured interviews in a 1-year period. Setting Volunteers were recruited through referrals, flyers, and face-to-face contacts from community health clinics, senior centers, acute care hospitals, and home care services in 2 urban counties in California between December 1997 and December 2000. Parti cipants A total of 297 persons between the ages of 23 and 97 years (35% Afr ican American, 33% Latino, and 32% Filipino American), of whom 42 (14%) had no health insurance. Main outcome measures Qualitative analysis of intervi ew data compared insured and uninsured respondents on a series of component s of chronic illness management, including control over illness, frequency of health crises, procuring medication, use of medication, understanding of the illness, knowledge of self-care measures, and awareness of risk factor s. Whether respondents were under the care of a regular physician was also assessed. Results Compared with insured respondents, uninsured respondents were much less effective at managing their illnesses. The uninsured had poo rly controlled illnesses, frequent health crises, difficulty procuring medi cation, used medication incorrectly, demonstrated poor understanding of the ir illness, and displayed little knowledge of self-care measures or risk aw areness. They rarely had a regular physician or attended a specific health clinic. Conclusions The findings suggest that not only did uninsured person s with chronic health conditions lack adequate health care, their illnesses were also poorly controlled. Inadequately educated about their health, uni nsured persons lacked the information, insight, and tools that would have a llowed them to manage their illnesses more effectively.