Losing and acquiring health insurance: consequences for health care

Data from a sample of 5530 Nebraska adults under age 65 are used to analyze the independent correlates of four different insurance statuses: insured 12 consecutive months, uninsured 12 consecutive months, insured at the end of a 12 month period, but not throughout, and uninsured at the end of a 12 month period, but not throughout. The effects of insurance status on utilization of health care services when perceived to be needed are assessed, controlling for demographic explanations. The results show that uninsurance status, whether long-lasting or recent, indicates lower utilization than being insured. Policies designed to expand the number of persons with insurance, especially those linked to practices of insurers, are predicted to have little impact since the underlying causes of uninsurance are related to household income. Lower use of health care services among the uninsured is thought to present financial problems to providers, since the uninsured who do seek care are more likely to need more services (without paying). Problems of higher cost to treat these individuals also present problems for public policies that in effect create subsidies to expand the number of insured. Finally, this study indicates that incremental policy approaches may not deal adequately with the fundamental problems that result in increases in the number of uninsured Americans and caring for their health care needs.