New study finds working age adults with major chronic conditions grew 25 percent over 10 years

As the number of working-age adults who have major chronic conditions grew between 1997 and 2006, those without health coverage in this group experienced substantial erosion in access to health care, according to a new study by Kaiser Family Foundation researchers published today as a Health Affairs Web Exclusive.

The number of working-age adults who reported having at least one of seven major chronic conditions grew 25 percent since 1997, to a total of nearly 58 million by 2006. Besides overall growth in the adult population, the increase over the period reflects rising rates of chronic disease prevalence among nonelderly adults.

The research focused on nonelderly adults with chronic conditions because their greater health needs make them particularly sensitive to changes in the economy and the health care system. Studies have found that people with chronic conditions disproportionately account for three-quarters of all personal medical spending in the United States. As the nation struggles with unchecked health care costs, growth in the chronically ill population and the potential consequences of their unmet needs for care is cause for concern.

The new study, authored by Catherine Hoffman and Karyn Schwartz, analyzes ten years of data (1997-2006) using access to care measures from the National Health Interview Survey for nonelderly adults having at least one of these seven major chronic conditions: heart disease, hypertension, stroke, diabetes, asthma, emphysema, and cancer. Within this group, comparisons were made between those who were uninsured, publicly insured through Medicaid, and privately insured.

While large differences in access to care between uninsured and insured adults with chronic conditions existed in 1997, the insurance divide grew even wider by 2006. In general, the proportions of Medicaid enrollees and privately insured people having problems getting care were similar, and both proportions were much lower than the proportion of the uninsured who experienced problems getting care, after adjusting for social and health differences among the different groups.

Regular monitoring and continuity in a person's care are important in managing a chronic condition effectively. Yet the authors found that:

• More uninsured adults with a chronic condition reported not having a usual source of care between 1997 and 2006 (growing from 29% to 34%) and not having seen a health professional at all during the year (growing from 21% to 26%). Also, by 2006, more of this group was not seeing medical specialists.
• In contrast, access to providers improved among the privately insured and was unchanged among those with Medicaid over time.

However, the rising costs of health care on top of slow growth in wages over this time period adversely affected both the insured and uninsured with chronic conditions. The authors found the following cost-related trends:

• More people in all three insurance groups reported having unmet needs for prescription drugs because of cost in 2006 compared to 1997. Among the privately insured with chronic conditions, the share reporting this access problem nearly doubled, growing from 5 percent in 1997 to 9.5 percent by 2006. The comparative trend among the uninsured: 25 percent growing to 33 percent; among those with Medicaid: 5 percent growing to 8 percent by 2006. With prescription drugs playing an increasing role in chronic condition management, this finding may be a particular cause for concern.
• In general, more of both the privately insured and uninsured with chronic conditions reported having an unmet need for care because of its cost over the period, while those with Medicaid coverage experienced no change. Still, the insurance divide remained wide, with the uninsured being more than four times as likely as the privately insured to have an unmet need for care (35% versus 8%).

Given the consistent erosion in heath care access among the uninsured over these ten years, and given that more people with insurance are now beginning to be affected as well, Hoffman and Schwartz conclude, "Controlling health system costs overall will require effective and efficient care for people with chronic conditions, because they use the majority of health care services in this country. These high costs put people with chronic conditions on the front lines to test major and even minor reforms of our health insurance system."

The full article, "Eroding Access among Nonelderly Adults with Chronic Conditions: Ten Years of Change," is available at www.kff.org or www.healthaffairs.org.

The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.