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

By Maureen McInaney

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
*  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.

The study was funded by grants from the National Institutes of Health, National
Institute on Aging. For more information about the study visit: