Loss of health insurance and the risk for a decline in self-reported health and physical functioning.

BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known.

SETTING: National survey.

PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992.

MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996.

RESULTS: In 1994, 5768 (95.0%) people continued to have private insurance, 229 (3.8%) reported having lost all insurance, and 75 (1.2%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6% for those who lost all insurance versus 7.2% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5% vs. 20.4%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95% CI, 0.90-1.68).

CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.