What’s Behind It?
Under federal law, no patient can be denied care in an emergency room because he or she lacks the ability to pay for services. California is fortunate to have a robust safety net, a network of public hospitals and community clinics that treat patients regardless of insurance status or ability to pay. These facts lead some people to conclude that uninsured Californians have access to the care they need.
The Broader Picture
Adults without coverage go without needed care. The uninsured are much less likely to receive preventive and routine care, such as mammograms, pap smears, or screenings for colon cancer. Only 18% of uninsured patients reported receiving a screening for colon cancer, compared to 56% of insured patients. While they can obtain care at the emergency department or a community clinic, uninsured adults are more likely to lack a regular source of care and more likely to forgo needed care. According to the Commonwealth Fund Biennial Health Insurance Survey, almost half of uninsured individuals will not seek care when they have a medical problem, compared to just 15% of insured individuals.
Adults without coverage have worse health outcomes. The Institute of Medicine reviewed 130 studies published in the past 20 years and found that uninsured patients consistently have worse health outcomes. For example, compared to patients with private insurance coverage:
- Uninsured patients with breast cancer have 30 to 50% higher mortality rates;
- Uninsured patients with colon cancer have 50 to 60% higher mortality rates; and
- Uninsured accident victims have a 37% higher mortality rate.
Other studies have found that uninsured patients with chronic conditions are almost twice as likely to visit an emergency department or be hospitalized as insured patients.
Short-term stabilization is not the same as long-term care health management. Because uninsured patients lack routine care, their chronic conditions are often poorly managed, increasing the likelihood of serious, acute complications. Once hospitalized, they receive treatment for acute needs but probably don’t receive appropriate follow-up care, resulting in worse health outcomes over the long term.
Uninsured children also lack access to care and experience worse health outcomes. Because uninsured patients lack routine care, their chronic conditions are often poorly managed, increasing the likelihood of serious, acute complications. Once hospitalized, they receive treatment for acute needs but probably don’t receive appropriate follow-up care, resulting in worse health outcomes over the long term.
The Bottom Line
Health coverage matters. Children and adults without health insurance can receive care from California’s safety net or in an emergency situation. However, studies consistently demonstrate that California adults and children without insurance have difficulty accessing needed care and are more likely to have worse health outcomes.
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For More Information
- Commonwealth Fund, 2005 Biennial Health Insurance Survey, 2006.
- Jack Hadley, “Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition,” JAMA, 2007; 297:1073-1084.
- Institute of Medicine, Care Without Coverage: Too Little, Too Late, 2002.
- Mathematica Policy Research, “Santa Clara Healthy Kids Program Reduces Gaps in Children’s Access to Medical and Dental Care, In Brief #2," 4/05.
