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Consequences of the Lack of Health Insurance on Health and Earnings

Cover Missouri Project: Report 1

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Document date: June 30, 2006
Released online: June 30, 2006

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.

Note: This report is available in its entirety in the Portable Document Format (PDF).

The text below is a portion of the complete document.


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).



Topics/Tags: | Health/Healthcare


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