As the number of working-age adults who have major chronic conditions grew between 1997 and 2006, persons without health coverage in this group experienced substantial erosion in access to healthcare, according to a new study (http://www.kff.org/uninsured/kcmu072208pkg.cfm) by Kaiser Family Foundation researchers published today as a Health Affairs Web exclusive. The number of working-age adults who reported having at least one of seven major chronic conditions grew by 25% since 1997, to a total of nearly 58 million by 2006. Besides the overall growth in the adult population, the increase over the period reflects rising rates of chronic disease prevalence among nonelderly adults.
The research focused on nonelderly adults with chronic conditions because their greater health needs make them particularly sensitive to changes in the economy and the healthcare system. Studies have found that people with chronic conditions disproportionately account for three-quarters of all personal medical spending in the United States. As the nation struggles with unchecked healthcare costs, growth in the chronically ill population and the potential consequences of their unmet needs for care is a cause for concern. The new study, authored by Catherine Hoffman and Karyn Schwartz, analyzes 10 years of data (1997-2006) using access to care measures from the National Health Interview Survey for nonelderly adults having at least one of these seven major chronic conditions: heart disease, hypertension, stroke, diabetes, asthma, emphysema, and cancer. Within this group, comparisons were made among individuals who were uninsured, publicly insured through Medicaid, and privately insured.
Although large differences in access to care between uninsured and insured adults with chronic conditions existed in 1997, the insurance divide grew even wider by 2006. In general, the proportions of Medicaid enrollees and privately insured people having problems getting care were similar, and both proportions were much lower than the proportion of the uninsured who experienced problems getting care, after adjusting for social and health differences among the different groups. Regular monitoring and continuity in a person's care are important in managing a chronic condition effectively. Yet the authors found the following:
* More uninsured adults with a chronic condition reported not having a usual source of care between 1997 and 2006 (growing from 29% to 34%) and not having seen a healthcare professional at all during the year (growing from 21% to 26%). Also, by 2006, more of this group was not seeing medical specialists.
* In contrast, access to providers improved among the privately insured and was unchanged among persons with Medicaid over time.
However, the rising costs of healthcare on top of slow growth in wages over this time period adversely affected both the insured and uninsured with chronic conditions. The authors found the following cost-related trends:
* More people in all three insurance groups reported having unmet needs for prescription drugs because of cost in 2006 compared to cost in 1997. Among the privately insured with chronic conditions, the share reporting this access problem nearly doubled, growing from 5% in 1997 to 9.5% by 2006. The following is the comparative trend among the uninsured: 25% growing to 33%; among those with Medicaid: 5% growing to 8% by 2006. With prescription drugs playing an increasing role in chronic condition management, this finding may be a particular cause for concern.
* In general, more of both the privately insured and uninsured with chronic conditions reported having an unmet need for care because of its cost over the period, whereas individuals with Medicaid coverage experienced no change. Still, the insurance divide remained wide, with the uninsured being more than four times as likely as the privately insured to have an unmet need for care (35% vs 8%).
Given the consistent erosion in healthcare access among the uninsured over these 10 years and the fact that more people with insurance are also beginning to be affected, the authors concluded that overall control of health system costs requires effective care for patients with chronic conditions, who use most healthcare services. The full article, entitled "Eroding Access among Nonelderly Adults with Chronic Conditions: Ten Years of Change," is available at http://www.kff.org or http://www.healthaffairs.org.
The Kaiser Family Foundation is a nonprofit, private operating foundation dedicated to providing information and analysis on healthcare issues to policy makers, the media, the healthcare community, and the general public. The foundation is not associated with Kaiser Permanente or Kaiser Industries.