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Study: Individuals with Chronic Disease Often Go Without Treatment

By Reed Cooley, CQ Staff

August 5, 2008 -- Many Americans with chronic diseases are forgoing needed care because they lack health insurance coverage, according to a report released Tuesday in the health journal Annals of Internal Medicine.

The study, which says it is the first in recent years to address the prevalence of chronic conditions among the uninsured, estimates that of the country's 47 million uninsured, 11.4 million are working-age adults suffering from at least one chronic condition, such as cardiovascular disease, diabetes or asthma.

Controlling for sociodemographic conditions, the study found that chronically ill individuals without insurance were four to six times more likely to have problems accessing care than those covered by private plans or one of the government entitlement programs. This group was more likely to use the emergency department for primary care and less likely to have visited a physician in the past 12 months, said the report, which points out that Americans without insurance tend to be less affluent than those covered.

The report noted that the number of individuals who are both uninsured and afflicted by chronic disease is likely underestimated because the study only counted those that had been diagnosed with an illness and many uninsured Americans may go undiagnosed.

An editorial accompanying the article said that the "clarion call" of increasing access to care by the uninsured would not be enough to sufficiently treat chronic diseases.

"Health care insurance reform is necessary for good care for chronic diseases, but it will not be sufficient unless it is coupled with quality improvement efforts targeting the reasons that vulnerable populations with access to care often do not receive optimal care," the editorial said.

The report concluded that treatment of the chronic diseases included in the study had become "the standard of care" in recent years.

"The benefits of treatment are so clear that studies evaluating new treatments of these conditions are ethically bound to provide control participants with standard therapies," the article said. "The same ethical consideration has not been extended to those without insurance."

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