Health consequences of uninsured adults: An updated review

Vinit Shashikant Patil; K Sidhulal; Nilima Vaghela; Uzma Belgaumi; PA Rafeeque; MM Siraj

doi:10.4103/ijmo.ijmo_8_22

REVIEW ARTICLE

Year : 2022 | Volume : 7 | Issue : 2 | Page : 42-44

Health consequences of uninsured adults: An updated review

Vinit Shashikant Patil¹, K Sidhulal², Nilima Vaghela³, Uzma Belgaumi⁴, PA Rafeeque⁵, MM Siraj⁶
¹ Consultant Oral Pathologist, Kozhikode, Kerala, India
² General Medical Practitioner, Kozhikode, Kerala, India
³ Clinical Practitioner, Daman, Daman and Diu, India
⁴ Reader, Oral and Maxillofacial Pathology, School of Dental Sciences, KIMS Deemed to be University, Karad, India
⁵ Consultant Physician and Intensivist, Kozhikode, Kerala, India
⁶ Consultant Anesthesiologist and Intensivist, Kozhikode, Kerala, India

Date of Submission	13-May-2022
Date of Acceptance	29-May-2022
Date of Web Publication	30-Dec-2022

Correspondence Address:
Dr. Vinit Shashikant Patil
Consultant Oral Pathologist, Kozhikode, Kerala
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmo.ijmo_8_22

Abstract

The health consequences of uninsurance are real, vary in magnitude in a clinically consistent manner. Health services research conducted over the past 25 years makes a compelling case that having health insurance or using more medical care would improve the health of the uninsured. Uninsured adults have less access to recommended care, receive poorer quality of care, and experience worse health outcomes than insured adults do. Uninsured adults forego preventive care and seek health care at more advanced stages of disease. Society then bears these costs through lower productivity, increased rates of communicable diseases, and higher insurance premiums. Some mortality studies imply that a 4%–5% reduction in the uninsured's mortality is a lower bound; other studies suggest that the reductions could be as high as 20%–25%. The potential health benefits of expanding insurance coverage for these adults may provide a strong rationale for reform. In its review study, we have highlighted the health consequences of uninsurance among adults.

Keywords: Chronic disease, health-care disparities, medically uninsured, outcome assessment

How to cite this article:
Patil VS, Sidhulal K, Vaghela N, Belgaumi U, Rafeeque P A, Siraj M M. Health consequences of uninsured adults: An updated review. Int J Med Oral Res 2022;7:42-4

How to cite this URL:
Patil VS, Sidhulal K, Vaghela N, Belgaumi U, Rafeeque P A, Siraj M M. Health consequences of uninsured adults: An updated review. Int J Med Oral Res [serial online] 2022 [cited 2023 May 28];7:42-4. Available from: http://www.ijmorweb.com/text.asp?2022/7/2/42/366313

Introduction

Lack of health coverage takes an enormous toll on the uninsured – in thousands of avoidable deaths each year, poorly managed chronic conditions, undetected or untreated cancer, and untried life-saving medical procedures. According to emerging research, being uninsured has multiple economic consequences as well. There are costs for individuals, in terms of poorer quality of life and reduced productivity; for businesses, whose employees miss work or retire early for health reasons; for the health-care system, which is burdened by bad debt and inefficient care for the uninsured; and for society at large, which forgoes the economic benefits of a healthy, productive population. Uninsurance makes it the sixth leading cause of death among people ages 25–64 years – after cancer, heart disease, injuries, suicide, and cerebrovascular disease, but before human immunodeficiency virus/acquired immunodeficiency syndrome or diabetes. Being uninsured exposes individuals to risks in addition to a greater probability of death. Often it means receiving poor-quality care.^{[1],[2],[3],[4],[5]}

Uninsured Versus Insured

The uninsured are less likely than the insured to have a regular source of care, less likely to receive preventive care, and less likely to benefit from early detection of medical problems. Furthermore, the uninsured are more likely to face burdensome medical bills. Adults lacking coverage make inefficient use of the health-care system, relying on costly emergency rooms, for example, when care could have been provided in lower-cost primary care settings. One study found that of 2 million emergency room visits a year, 33% were for health conditions that did not require immediate care or could have been treated during a physician visit. When an uninsured patient sees a primary care physician but is unable to follow through with recommended care – by filling a prescription or undergoing tests – the initial investment in the medical consultation is squandered. The instability of the health insurance system – in which about half of the 41 million uninsured lose their coverage in a given year – generates administrative costs as well. When individuals move between public and private coverages, they often change their sources of medical care. As a result, medical records often need to be updated or transferred and insurance eligibility needs to be verified. The interruptions to care experienced by the uninsured may also contribute to higher health-care costs. one study found that Medicare beneficiaries who had the same physician for 10 years or longer had fewer hospitalizations and lower medical expenses.^[6],[7],[8]

Costs Borne of Uninsured by Taxpayers

Taxpayers pay some of the hidden costs associated with the uninsured. Federal, state, and local governments support care of uninsured patients through public health clinics and through payments to safety-net hospitals that care for the poor and uninsured. A recent study documented that these governmental expenditures total approximately $30.6 billion a year. Moreover, fewer taxpayers are shouldering the costs of financing government services when these patients are forced by their illness or injury to work reduced hours or to stop working temporarily, and thus no longer have earnings on which they pay taxes. Costs Borne by the general public inadequate health care for the uninsured also generates hidden costs that fall upon the public. Contagious diseases that go untreated because the carrier lacks insurance threaten the health of the entire population. Teaching hospitals and major medical centers that are strained financially from providing uncompensated care are less able to provide high-level burn or cancer care. Moreover, emergency rooms that fill with uninsured, nonemergency patients are often compelled to divert patients requiring immediate care to other institutions.

Health Insurance and Quality of Care

The available literature on health insurance and quality of care could be categorized into five

Some studies indicate that health insurance is positively associated with improved quality of care. Overall, those who were insured gave significantly higher ratings of excellent/good (81% vs. 71%) compared to those who were uninsured. Nevertheless, they paid significantly less than the uninsured
Other studies, however, suggest that health insurance tends to have a negative influence on the quality of care. Most of the insured experienced longer waiting times, more verbal abuse, and other various forms of discrimination against them, compared with the uninsured patients. The insured attributed their experiences to the fact that they were not making immediate out-of-pocket payments for services, as providers preferred clients who would make instant payments for health-care services
A third category of literature, however, indicates that quality of care experiences may differ between insured and uninsured patients in the same health facility, depending on the nature of the service provided or the attitude of the service provider. Research showed that providers were less likely to weigh, take the temperature, perform a physical examination, use a stethoscope, and inform patients about the diagnosis of their illness when the patients were enrolled in community-based insurance. The authors, however, found that there was no difference between the enrolled and nonenrolled respondents about the availability of medicines. Both insured and uninsured households had positive perceptions with regard to the technical (objective) quality of care but were negative about providers' attitudes (interpersonal quality of care). The attitude of staff toward insured patients also differs, even in the same health facility. In India, a focus group discussion with staff at hospital found that whereas some patients complain that the nurses in the hospital reproach them for “being uninsured,” some of the staff rather considered the insured patients as a nuisance
A fourth category of literature indicates that insurance status has no influence on the quality of care received by patients. A study on a community microinsurance scheme in India to assess whether insurance status improves health-care quality. It was found that being insured is not significantly associated with receiving better-quality care, even when controlling for several patient and facility characteristics. In Ghana, a study conducted by the National Development Planning Commission reports that <50% of respondents indicated that quality has improved following the implementation of the national health insurance scheme
Finally, several studies show that even though poor quality of care may affect both insured and uninsured patients in health facilities, it poses a disincentive to enrollment or renewal of membership of health insurance scheme.^{[6],[7],[8],[9],[10]}

Perceptions of Quality of Care between Insured and Uninsured

There is no significant difference in perceptions of fairness of care between the insured and uninsured patients, this is contrary to anecdotal and empirical evidence that insured and uninsured patients are treated unequally, with the former receiving the relatively poorer quality of care compared with the latter. There is no significant difference between the insured and uninsured patients regarding the adequacy of resources and services, except on waiting time which is less favorable to insured patients. The significant difference between the insured and uninsured on effectiveness of treatment for recovery and cure could be due to the fact that the insured patients have better access to health care and therefore are able to treat their illnesses early enough before they become complicated. It could also be due to the possibility of insured patients enjoying better health outcomes, resulting from accurate diagnosis based on laboratory and other diagnostic investigations.^{[9],[10],[11]}

Conclusion

This review study finds that overall, there is no significant difference in perceptions of quality of care between insured and uninsured patients. However, some indicators show significant differences in perceptions of quality of care, the key among which is financial access to care. It is a good sign also that insured patients are more likely to undergo laboratory and other diagnostic investigations for accurate diagnosis of their illnesses, and are also more likely to report the effectiveness of treatment for recovery and cure. The study thus concludes that generally, insured and uninsured patients are not treated unequally, in terms of quality of care in hospitals. On the contrary, insured patients have an advantage in terms of access to quality health care. The study, however, finds that generally, quality of care is fairly satisfactory to both insured and uninsured patients, which suggests that quality of care remains an issue deserving serious attention by health service providers. Critical quality issues which could have serious consequences for the successful implementation of the health insurance scheme include the collection of unofficial fees from patients by some health-care providers, inadequacy of doctors, and long waiting times. Thus, measures must be taken to address the unacceptable attitudes of some health-care providers, as well as improve the general level of quality of care in hospitals. More research is needed to tally the multitude of direct and indirect costs of not providing health insurance to one-seventh of the population. However, there is already accumulating evidence that this policy failure is exacting heavy costs for the insured, for employers, for taxpayers, and for the health system and general public. Clearly, the time has come for immediate action to ensure a healthier and more productive society.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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