Health Care Costs and Financing

Insuring adults in late middle age may reduce the costs of paying for health problems later

The lack of insurance is consistently associated with a higher risk of decline in overall health for adults in middle to late middle age. A study supported by the Agency for Healthcare Research and Quality (HS10283) indicates that insuring this age group now could lead to improved health status and reduce costs later in life.

David W. Baker, M.D., M.P.H., of Northwestern University and colleagues analyzed data from the Health and Retirement Study (HRS), a prospective study of a national sample of community-dwelling adults 51 to 61 years old from 1992 to 2002. The researchers analyzed the relationship between insurance coverage and health outcomes by examining each one at 2-year intervals between HRS interviews over the 10-year study period.

People who were uninsured at baseline had a 35 percent higher mortality rate (adjusted for risk factors) than those with private insurance from 1992 to 2002. However, when the outcomes were analyzed over 2-year intervals, individuals who were uninsured at the start of each interval were 43 percent more likely to have a major decline in their overall health, and they were as likely to die as the privately insured. Of the 1,512 people who were uninsured at baseline, 220 (15 percent) died. Of those who died, only 70 (32 percent) were still uninsured at the HRS interview prior to death, and 150 (68 percent) died during a period when they had insurance coverage.

The average annual health care expenditure in 2001 for someone aged 51 to 61 was $12,578 for those in poor health and $6,938 for those in fair health. In contrast, the average annual total health care costs for healthier adults in this same age group were $3,922 for those in good health and $1,791 for those in excellent health. Thus, even a modest reduction in the number of uninsured individuals who transition to fair or poor health could yield long-term reductions in health care costs to partially offset the cost of covering the uninsured, suggest the researchers.

See "Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1991-2002," by Dr. Baker, Joseph J. Sudano, Ph.D., Ramon Durazo-Arvizu, Ph.D., and others, in the March 2006 Medical Care 44(3), pp. 277-282.

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