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Uninsured as Likely as Insured to Perceive Need for Care but Half as Likely to Get Care

Study Shows Lack of Insurance Not Preferences Keep Uninsured People From Getting Care

News Release
October 19, 2005

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—When confronted with a serious new medical symptom, insured and uninsured people share similar perceptions about the need to see a medical provider, according to a new national study by the Center for Studying Health System Change (HSC). However, among people who believed they needed care, the uninsured were less than half as likely to get care.

Some contend that uninsured people are less likely to use care, either because they are healthier or, if they do become sick, because they have different attitudes or preferences that make them less likely to seek care. Moreover, some contend that when the uninsured do get sick and need care, they are able to get care from safety net providers or by paying out of pocket.

"The study underscores that lack of insurance—not different perceptions or preferences—is the major factor that keeps people from getting care when they develop a serious new symptom," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

The study found that uninsured people 18 and older were significantly more likely—23.2 percent of the uninsured compared with 18.9 percent of the insured-to report the recent onset of at least one of 15 serious symptoms, such as shortness of breath, chest pain, persistent headache or loss of consciousness.

Overall, about 58 percent of insured and uninsured people with a new symptom believed they needed to see or talk to a medical provider. However, even with similar conditions and similar severity levels, uninsured people were much less likely than the insured to obtain medical care in response to the new symptom. Among those who believed that they needed to seek care, 82 percent of the insured saw or talked to a medical provider, compared with 37 percent of the uninsured.

Based on HSC’s Community Tracking Study Household Survey, a nationally representative survey of 46,600 persons, the study asked people whether they had experienced any of 15 symptoms identified by a panel of physicians as either potentially life threatening or having a significant impact on quality of life if not treated. A random subset of 16,266 adults was asked these questions, and 3,299 indicated that they had experienced at least one new symptom within the last three months. This analysis is limited to 1,939 adults without Medicare coverage—1,024 uninsured and 913 insured people.

Differences in perceived need for care also are sometimes used to explain differences in access and use of services among whites and minorities; higher-income and lower-income people; and people with limited education. However, the study found that there are minimal differences in the perceived need for care for these 15 symptoms by race/ethnicity, income or education. Racial and ethnic minorities, lower-income people, and people with less-than-college education have similar perceptions of when care is needed as whites, higher-income people, and people with college educations.

"The findings contradict contentions that differences in use of services between the insured and the uninsured, between whites and racial/ethnic minorities, or between higher- and lower-income people are a result of differences in perceptions about when care is needed," said HSC Senior Fellow Jack Hadley, Ph.D., coauthor of the study with HSC Senior Health Researcher Peter J. Cunningham, Ph.D.

The study’s findings are detailed in a new HSC Issue Brief—Perception, Reality and Health Insurance: Uninsured as Likely As Insured to Perceive Need for Care but Half as Likely to Get Careavailable here.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.



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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.