Health Care Costs and Financing

Use of heath care among the uninsured increases over time during the first year without insurance

The uninsured are increasingly likely to use health care services as the months pass during the first year of their becoming uninsured, according to a new study. Researchers analyzed data on the uninsured from the Agency for Healthcare Research and Quality (AHRQ) 1996-2002 Medical Expenditure Panel Survey (MEPS). This national survey contains information on the use of health services, insurance, and the health status of individuals.

The probability of using health care services increased during the first year of an uninsured episode, with more health care use in the second 6 months compared with the first 6 months. Health care use may rise during the first year of an uninsured episode because it takes time for individuals to find low-cost or free health care in their communities. In addition, the uninsured may delay seeking health care, believing they will become insured once again in the near future. After several months without insurance, however, they may no longer be able to delay care, explain the researchers.

The difference in use of care over time suggests the importance of controlling for time since the uninsured episode began when estimating the effects of policies on access to care among the uninsured. The findings also suggest that interventions targeted at the uninsured may need to be tailored to individuals depending on how long they have been uninsured. The researchers found little evidence that the final length of time without insurance, whether a few months or a year or more, affected when health care was used. This may be because individuals are unable to anticipate changes in their insurance coverage or they can anticipate when they will become insured, but their care is not discretionary. The study was supported in part by the Agency for Healthcare Research and Quality (HS10770).

See "Individuals' use of care while uninsured: Effects of time since episode inception and episode length," by Carole Roan Gresenz, Ph.D., Jeannette Rogowski, Ph.D., and José J. Escarce, M.D., Ph.D., in the December 2008 Journal of the National Medical Association 100(12), pp. 1394-1404.

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