Universal Health Insurance Coverage Reduces Disparities in Health Outcomes

"Nearly 50 million U.S. residents lack health insurance, and a great deal of the work on health disparities has focused on comparisons between them and insured persons. From a descriptive perspective, we know that uninsured persons have worse health outcomes than insured persons." For example, when uninsured:

• Such patients may delay seeking care because of cost concerns and, overall, they receive less ambulatory care and diagnostic tests
• They have more difficulty obtaining prescription medications
• If they are accident victims, they have a 37% higher mortality
• As breast cancer patients, they have 30-50% greater mortality

The authors state: "Sadly, this descriptive and mechanistic knowledge has not yet led to insurance interventions designed specifically to reduce disparities. As a result, our understanding of insurance interventions is limited to what we can glean from natural experiments, such as evaluations of persons newly eligible for insurance coverage."

Examples:

• SCHIP or the State Children's Health Insurance Program (created in 1997) covers children of low-income families who don't qualify for Medicaid.  It  improves accessibility, the use, and the apparent quality of care; it reduces or eliminates "preexisting racial and ethnic disparities."
• "Eligibility for Medicare coverage is also associated with increased use of health services and improved self-reported health status, as well as some reductions in disparities in these outcomes."

In conclusion, the authors augur for comprehensive, universal health care.

Sehgal AR. "Universal Health Care as a Health Disparity Intervention." Ann Int Med. April 21, 2009;150(8):561-562