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Nearly one in five nonelderly U.S. adults—mostly the poor, minorities, and less educated individuals—were uninsured in the first half of 2000. Individuals without health insurance coverage for 6 months or more have reduced use of preventive care services, conclude Heather L. Bednarek, Ph.D., of St. Louis University, and Barbara Steinberg Schone, Ph.D., of the Agency for Healthcare Research and Quality. They used data from the 1996 Medical Expenditure Panel Survey to assess the association between preventive care services (for example, mammograms, cholesterol checks, Pap smears, and influenza shots) and the length of time with insurance during a 12-month period: insured all 12 months, insured 7-11 months, insured 1-6 months, uninsured all 12 months.
Even after controlling for other factors, individuals who lacked insurance for longer periods had lower rates of preventive care use. Individuals who had continual insurance coverage during the entire period had dramatically higher rates of preventive service use than those who lacked coverage for all 12 months. Differences ranged from 10.2 percentage points for influenza immunizations (19.7 vs. 9.5 percent) to 37.6 percentage points for mammograms (66.7 vs. 29.1 percent). With the exception of blood pressure checks, physical exams, and prostate exams, they also found modest differences in use of preventive care between the continually insured and those covered for only 1 to 6 months.
However, rates of preventive care use for individuals with 7 to 11 months of coverage (short-term uninsured) were indistinguishable from the continually insured. For the most part, there was no difference in use of preventive care by people who were continually or partially insured with public or private insurance.
See "Variation in preventive service use among the insured and uninsured: Does length of time without coverage matter?" by Drs. Bednarek and Schone, in the Journal of Health Care for the Poor and Underserved 14(3), pp. 403-419, 2003.
Reprints (AHRQ Publication No. 03-R066) are available from the AHRQ Publications Clearinghouse.
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