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Individuals who have lapses in insurance coverage are less likely to use preventive services than those with continuous coverage

People who lose health insurance coverage for any period are less likely than those who are continuously insured to use preventive care services such as cholesterol screening and mammograms, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10283). Policy initiatives are needed to promote stability in insurance coverage, suggest Joseph J. Sudano, Jr., Ph.D., of Case Western Reserve University Medical School, and David W. Baker, M.D., M.P.H., of Northwestern University. They used data from the 1992, 1994, and 1996 National Health and Retirement Study to focus on how insurance status in 1994 and 1996 and episodes of noncoverage during 1992 through 1996 predicted use of preventive services among 7,300 older adults.

More than 15 percent of participants were uninsured at the baseline interview in 1992. However, insurance status at one point in time clearly does not tell the whole story. Between 1994 and 1996, 3.4 percent of those interviewed lost coverage, and 4.9 percent obtained coverage. Overall, 21.2 percent reported having at least one episode of noncoverage between 1992 and 1996. Thus, the pool of individuals who were continuously or intermittently uninsured was about 40 percent greater than that estimated from 1992 insurance status alone.

Over three-fourths (77 percent) of those who were continuously insured during the 4-year period received a mammogram compared with 62 percent who had one uninsured period and 53 percent who had two uncovered periods. Also, 74 percent of people who were continuously insured had a cholesterol test versus 64 percent of those with one uncovered period and 54 percent with two uncovered periods. Finally, 41 percent of the continuously insured received influenza vaccinations versus 34 percent of those with one uncovered period and 29 percent with two uncovered periods. In addition, people who obtained insurance coverage during the study period did not rapidly "catch up" with their already-insured peers in use of preventive services.

More details are in "Intermittent lack of health insurance coverage and use of preventive services," by Drs. Sudano and Baker, in the January 2003 American Journal of Public Health 93(1), pp. 130-137.

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