Percentage of North Carolinians lacking health insurance rises, UNC study shows

December 06, 2005

The proportion of North Carolinians under age 65 who lacked health insurance for at least a year rose from 15.3 percent in 2000 to 17.5 percent in 2004, according to a new University of North Carolina at Chapel Hill study.

Percentages of non-elderly residents without health insurance varied widely across the state, from a low of 13.9 percent in Wake County to a high of 28.3 percent in Tyrrell County, researchers say.

Lack of health insurance is a particularly acute problem in eastern North Carolina, they found. Eight of the 10 counties with the highest proportion of uninsured lie east of Interstate 95.

Cecil G. Sheps Center for Health Services Research staff conducted the analysis of two years of Current Population Survey data. Drs. G. Mark Holmes and Thomas C. Ricketts wrote the report, "County Estimates of the Number of Uninsured in North Carolina: A 2004 Update." In it, they calculated uninsured rates for state residents under age 18 and between ages 18 and 64.

Holmes is a research fellow with the Sheps center's Program on Health Economics and Finance and vice president of the North Carolina Institute of Medicine. Ricketts is deputy director for policy analysis at Sheps and professor of health policy and administration at the UNC School of Public Health.

"The uninsured have few reasonable cost options for health care, sometimes forcing them to ignore medical conditions until they become an emergency," Holmes said. "Once in the emergency department of a hospital, the uninsured's medical bills are often shared by everyone. This is a classic example of why it is in the public's best interest to find solutions to the high numbers of uninsured in our state."

Besides Wake and Tyrrell, counties at opposite ends of the coverage spectrum included Mecklenburg with 14.8 percent uninsured and Duplin and Hyde with 26.9 percent and 26.2 uninsured, respectively, he said. Orange County ranked 7th best with 16.3 percent uninsured, and Durham County was 5th best with 16.1 percent.

"Having access to estimates of the percentage of local residents without health insurance enables institutions such as public health departments, hospitals and physicians to plan for meeting the needs of the uninsured population," Holmes said. "It also allows policymakers to determine where to best target their efforts. Counties with lower average income and a higher proportion of workers employed by small business tend to have lower rates of health insurance coverage."

The full report, including the uninsured rates for children and adults for all 100 North Carolina counties, is available on the internet at under "What's New?"

The work was a collaborative effort of the N.C. departments of health and human services and of insurance, the Sheps center and the N.C. Institute of Medicine. A grant from the U.S. Department of Health and Human Services enabled researchers to examine N.C. data on the uninsured, identify policy options to expand coverage and develop cost estimates for those options.
Sheps center staff members seek to improve public health by understanding problems, issues and alternatives in health-care services. Toward that end, they maintain an interdisciplinary program of research, consultation, technical assistance and training, focusing on the accessibility, adequacy, organization, costs and effectiveness of those services and disseminate information to policymakers and the public.

Note: Holmes can be reached at 919-966-9694 or
Ricketts at 966-5541 or

Sheps Center contact: Christine Shia, 919-843-7661 or
News Services contact: David Williamson, 919-962-8596

University of North Carolina at Chapel Hill

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