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David W. Baker, MD, MPH; Martin F. Shapiro, MD, PhD; Claudia L. Schur, PhD

Arch Intern Med. 2000;160:1269-1274.

Background  The uninsured receive less medical care than the insured. However, it is not known whether the uninsured are less likely to seek medical care for highly "serious" or "morbid" symptoms.

Methods  Participants in the National Access to Care Survey were asked whether they had experienced any of 15 highly serious or morbid symptoms. Those who did were asked whether they received medical care and, if care was not received, whether care was thought to have been necessary.

Results  A total of 574 respondents (16.4%) reported 794 new serious or morbid symptoms. Of these, 499 people (86.9%) had health insurance, and they reported 691 new symptoms; 75 (13.1%) lacked health insurance, and they reported 103 symptoms. The uninsured were less likely to have received medical care and more likely to say they did not receive care even though they thought it was needed (P=.001). Medical care was received for 45.4% of symptoms for the insured and 24.3% for the uninsured; care was not thought to have been needed for 41.0% of symptoms for the insured and 45.6% for the uninsured; and care was thought necessary but was not received for 13.6% of symptoms for the insured and 30.1% for the uninsured. In multivariate analysis, the uninsured were much less likely to have received care than the insured (adjusted odds ratio, 0.43; 95% confidence interval, 0.23-0.81).

Conclusion  Lack of health insurance is a major barrier to receiving medical care, even for highly serious and morbid symptoms.

From the Departments of Medicine and Epidemiology & Biostatistics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Baker); the Department of Medicine, University of California at Los Angeles School of Medicine (Dr Shapiro); and Project HOPE Center for Health Affairs, Bethesda, Md (Dr Schur).

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