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Note: This report is available in its entirety in the
Portable Document Format (PDF).
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In 2005, between 635,000 and 707,000
Missouri residents were without health
insurance. Additionally, changes to the
state's Medicaid program in 2005
substantially increased the number of
uninsured. This first Cover Missouri Project
report presents an overview of the serious
health and financial consequences associated
with being uninsured and examines how
much insurance matters in relation to
people's access to care, use of services, and
ultimately health outcomes.
The link between health insurance and
health status has been documented in major
reports1-6 published between 2000 and 2004
by the American College of Physicians, the
Institute of Medicine (IOM), and others.
Those reports established that lack of health
insurance creates substantial financial barriers to receiving medical care. An
extensive body of research found that, on
average, the uninsured receive about half as
much medical care as the insured.
More important, the reports collected a
solid base of evidence supporting the
conclusion that lower use of medical care by
the uninsured results in poorer health status
for these individuals. The uninsured use
fewer screening and prevention services and
delay seeking care when sick. As a result,
when they do enter the medical care system,
they tend to be sicker and at more advanced
disease stages than the insured. Moreover,
even when seriously ill or suffering from an
identified chronic condition, the uninsured
receive less care than the insured. Together,
these factors result in higher rates of
morbidity and mortality for the uninsured,
both in general and for specific diseases.
Poor health exacts an obvious and direct
physical impact on people. It also has a
significant economic impact in the form of
lost earnings due to fewer years of healthy
life and lower productivity while at work.
These economic costs are substantial and
represent a hidden cost of uninsurance, over
and above the cost of the medical care used
by the uninsured.
This Cover Missouri Project report highlights
and updates key findings from
research studies, organizing the results
around a series of propositions about the use
of health services and health outcomes of
the uninsured. Specifically, this report poses
and presents evidence in support of the following hypotheses. Relative to the privately
insured, the uninsured are:
- more likely to postpone or fail to receive
needed medical care;
- less likely to be screened for serious
illnesses;
- more likely to enter the health care
system in poorer health;
- more likely to receive less treatment,
even for serious acute or chronic health
conditions; and
- more likely to have worse health
outcomes, both in general and for
specific diseases.
Note: This report is available in its entirety in the
Portable Document Format (PDF).
The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.
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