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Posted by tonyb on August 14, 2000 at 04:22:10:

NEW YORK (Reuters Health) - While politicians debate about getting more health insurance for uninsured
Americans, many people who are insured find that they still cannot afford the care they need, according to
new study findings.

"Changes in the healthcare marketplace have begun to test the nature and adequacy of health insurance,"
note Dr. Karen Donelan of the Harvard School of Public Health in Boston, Massachusetts, and colleagues.
"We would do well to consider the comprehensiveness, affordability, and quality of insurance available."

The researchers surveyed more than 4,000 adults aged 18 to 64, all of whom had health insurance at the
time of the survey. The study focused particularly on those with low or moderate incomes, defined as
having annual incomes below $20,000 or between $20,000 and $35,000, respectively.

Participants were asked about their healthcare experiences over the previous year, including whether had
trouble paying their medical bills and whether they had received the care they needed. The results are

"Despite having insurance, substantial proportions of insured adults reported medical cost burdens
and/or went without needed healthcare due to costs," Donelan and colleagues report.

"Nearly 1 in 5 insured adults said that there was a time in the past year when they did not have enough
money to pay for medical bills, prescription drugs, or other healthcare costs," the authors indicate.

About 14% also reported having problems paying for housing and utilities, and 11% said they had had
trouble buying food, according to the report.

Many people assume that having health insurance means people will receive the care they need without
undue financial burdens. This is not true for many of those with low or moderate incomes, the researchers
write in the August 11th issue of the online journal Medscape General Medicine.

"Adults with annual incomes below $20,000 were more likely than those with higher incomes to have
problems paying medical bills, despite being insured," Donelan and colleagues report.

The investigators note that 45% of those in this low-income group said they had been unable to pay
medical bills in the past year, compared to 13% of those who made between $35,000 and $60,000 a year,
and only 4% of those who earned more than $60,000.

About one in five of those in the two lower income groups said they had been contacted by collection
agencies about unpaid medical bills, and these numbers rose significantly among those with health
problems, the researchers found.

About one quarter of those in the two groups earning less than $35,000 yearly reported times when they
did not see a doctor when sick and/or fill a needed prescription because of cost.

The financial burden of healthcare falls especially heavily on those with low or moderate incomes who are
in poor or fair health, the report indicates.

Among these groups, between one third and one half of insured adults with health problems reported
problems getting or paying for the care they needed.

"If this were an article about people with low or modest incomes and without any insurance, we would
perhaps not be surprised to find such high rates of problems with access to care, financial crises, and
collection agencies.... But this study is about people who have insurance policies," Donelan and
colleagues write.

"These adults struggle to afford (insurance) premiums, get the healthcare they need when sick, and
balance the potential and actual cost against other basic living expenses. At the same time, their
insurance policies apparently are not offering the guarantee of protection when people are sick," the report


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