Uninsured patients don't manage chronic illness well, UCSF study finds

July 03, 2001

Compared to insured health care consumers, uninsured people are much less effective at managing their illnesses. Specifically, they have frequent health crises, difficulty getting medication and using it correctly, poor understanding of their illness and little knowledge about self-care or risk awareness, according to Gay Becker, PhD, professor of medical anthropology in the UCSF Institute for Health and Aging. The findings appear in the July issue of Western Journal of Medicine.

While the insured reported occasional health crises, the uninsured reported an ongoing chain of health crises. This suggests that being uninsured with a chronic illness may lead to greater illness severity and premature death, Becker said. It may also account, in part, for higher death rates for certain illnesses such as hypertension and diabetes among the uninsured, she said.

"Effective illness management has a battery of components, including symptom recognition; understanding how a particular illness works; and following a daily regimen that includes regular medication use, self-care practices, and risk awareness and prevention. The uninsured are simply unable to articulate these different components," said Becker. She explained that uninsured respondents rarely had a regular physician or consistently used a specific health clinic. In addition, they constantly struggled to secure medication.

"Despite perceptions of poor, uninsured persons as inattentive, problem-ridden, and difficult to treat, the uninsured are trying to control their illnesses. Although they often have many other concerns, such as securing adequate food, shelter, finances, and caring for family members, they appreciate information about illness management and try to act on medical advice," said Becker. She added that this research attests to the critical importance of free community clinics for the uninsured.

Becker suggests that health providers can make a difference in three ways:

· First, providers need to be alert to patients who are unmedicated or undermedicated. Access to medication postpones the recurrence of acute illness.
· Second, providers can help uninsured patients by talking with them about the specifics of chronic illness management. Providing written guidelines in the patient's first language may facilitate this process.
· Third, providers should develop a treatment plan with uninsured patients. Even with patients who may never be seen again, patients carry this information with them to the next medical encounter.

The findings are based on two large qualitative studies that examined daily management of chronic illness in different age groups. Respondents were African Americans, Latinos, and Filipino Americans between the ages of 23 and 97 who had one or more chronic illnesses - the most common of which were diabetes, asthma, heart disease and hypertension. Uninsured respondents comprised 14 percent of the sample.
-end-
The study was funded by grants from the National Institutes of Health, National Institute on Aging. For more information about the study visit: http://www.ewjm.com

University of California - San Francisco

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