It will be no surprise to Health Populi readers that the U.S. has a pretty poor record in managing chronic care. How bad those results are depends on whether you’re insured.

All of this may seem rather intuitive, but the latest research published in the Annals of Internal Medicine is important.

In A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults, published August 5, 2008, the team from the Cambridge Health Alliance/Harvard Medical School dove into detailed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004.

Until this study, the rate of chronic illness among the uninsured was not well documented, the researchers note.


11 in 36 million — 30.6% — of uninsured working-age people have at least one chronic condition. The study found that among working-age Americans with chronic conditions who were uninsured, 16.1% had cardiovascular disease, 15.5% had hypertension, and 16.6% had diabetes.

This study in fact undercounts the number of those with chronic conditions as the data are self-reported by people — many of whom don’t even know they are suffering from, say, high blood pressure or diabetes.

The conclusion: after controlling for age, sex, race and ethnicity, chronically ill patients without insurance were more likely than those with coverage to have not visited a health professional (22.6% vs. 6.2%) and to not have a standard site for care (26.1% vs. 6.2%).

People who were uninsured were nearly 7x more likely to identify their standard site of medical care as an emergency room.

Health Populi’s Hot Points: An emergency room is hardly the medical home of choice for an American citizen. The unintended consequences of uninsurance are sicker and sicker people showing up in overcrowded emergency departments costing more money to care for than they would otherwise have consumed if their conditions had been diagnosed and managed correctly sooner.

Again, obvious and intuitive. These data bolster the argument for universal coverage.

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