Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition

CONTEXT: Given the large and increasing number of uninsured US individuals, identifying the health consequences of being uninsured has assumed increased importance. OBJECTIVE: To compare medical care use and short-term health changes among US uninsured individuals and insured nonelderly individuals following a health shock caused by either an unintentional injury or the onset of a chronic condition. DESIGN, SETTING, AND PARTICIPANTS: Multivariate logistic regression analysis of longitudinal data from Medical Expenditure Panel Surveys (1997-2004) limited to nonelderly individuals whose insurance status was established for 2 months prior to 1 or more unintentional injuries (20 783 cases among 15 866 individuals) and onset of 1 or more chronic conditions (10 485 cases among 7954 individuals). MAIN OUTCOME MEASURES: Self-reported medical care use and change in short-term general health status following the health shock. RESULTS: After experiencing a health shock, uninsured individuals were less likely to obtain any medical care (unintentional injury UI group: 78. 8% uninsured vs 88. 7% insured adjusted odds ratio AOR, 0. 47; 95% confidence interval CI, 0. 43-0. 51; new chronic condition NCC group: 81. 7% uninsured vs 91. 5% insured AOR, 0. 45; 95% CI, 0. 40-0. 50) and more likely not to have received any recommended follow-up care (UI group: 19. 3% uninsured vs 9. 2% insured AOR, 2. 59; 95% CI, 2. 15-3. 11; NCC group: 9. 4% uninsured vs 4. 4% insured AOR, 1. 65; 95% CI, 1. 32-2. 06). Based on the AORs, uninsured individuals with UIs had fewer outpatient visits (6. 1% uninsured vs 9. 0% insured; AOR, 0. 71 95% CI, 0. 63-0. 80), office-based visits (41. 8% uninsured vs 57. 3% insured; AOR, 0. 59 95% CI, 0. 56-0. 62), and prescription medicines (35. 5% uninsured vs 35. 6% insured; AOR, 0. 71 95% CI, 0. 67-0. 75). Uninsured individuals with an NCC had fewer office-based visits (58. 9% uninsured vs 68. 3% insured; AOR, 0. 77 95% CI, 0. 72-0. 82) and prescription medicines (52. 7% uninsured vs 61. 7% insured; AOR, 0. 66 95% CI, 0. 57-0. 76). Higher proportions of uninsured individuals reported a decrease in health status (classified as much worse) approximately 3. 5 months after the health shock (UI group: 9. 8% uninsured vs 6. 7% insured; AOR, 0. 86 95% CI, 0. 75-0. 98; NCC group: 12. 3% uninsured vs 10. 1% insured; AOR, 0. 74 95% CI, 0. 68-0. 80). Uninsured individuals with UIs were more likely to report not being fully recovered and no longer receiving treatment. At approximately 7 months after the health shock, uninsured individuals with NCCs still reported worse health status. CONCLUSIONS: Among individuals who experienced a health shock caused by an unintentional injury or a new chronic condition, uninsured individuals reported receiving less medical care and poorer short-term changes in health than those with insurance.