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Many Older Adults at Risk for Being Uninsured Prior to Medicare Eligibility

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April 13, 2005

Fully 25 percent of Americans will be uninsured at some point during late middle age, greatly increasing their risk for death or a decline in their overall health prior to retiring and becoming eligible for Medicare, finds a study in the April 11 issue of Archives of Internal Medicine.

“Uninsured individuals are less likely to have a regular source of care, to use preventive services, to obtain timely care for acute medical problems and to take medications for chronic illnesses,” said study author David W. Baker, M.D., associate professor of medicine at Northwestern University Feinberg School of Medicine. “As a result, uninsured patients have higher rates of illness and death.”

There has been increasing concern over the number of near-elderly Americans who lack health insurance. Findings from this study suggest the problem is even larger than previously believed, Baker said.

Baker and Joseph J. Sudano, of Case Western Reserve University, found that women, African American and Hispanic individuals and those with low educational attainment and/or low adjusted family income were more likely to be uninsured one or two times over the eight-year study period.

Older age, male sex, poor overall health, having one or more chronic illnesses and being uninsured at the start of the study were all associated with higher risk for death.

Participants’ income at the beginning of the study showed a very strong relationship to being uninsured two or more times, and having less than a high school education was also independently associated with being without insurance multiple times.

The number of chronic diseases was inversely related to being without health insurance multiple times.

“There is now substantial evidence that uninsured adults in their pre-retirement years are at greatly increased risk for adverse health outcomes, and urgent policy measures are needed to expand coverage for this group,” Baker and Sudano said.

The researchers analyzed data from the Health and Retirement Study of 6,065 participants aged 51 to 57, who were interviewed every two years from 1992 to 2000 to assess the number of patients whose health is at risk due to being uninsured. At the time of interview, insurance coverage was determined and classified as private, public or uninsured.

The percentage of uninsured individuals decreased throughout the study period. Often, people shifted between having insurance and being uninsured. Only about 60 percent of patients were continuously enrolled in private insurance through all five interviews.

Results of this study show the tremendous importance of public insurance programs as a safety net for limiting the number of uninsured, the authors said.

This safety net is essential for older adults with severe health problems whose ability to get private health insurance is limited because of restricted employment opportunities and the high cost of individual health insurance policies for people with pre-existing conditions.

Topics: Research