Uninsurance and Health Care Quality and Disparities: Findings from the 2009 National Healthcare Quality and Disparities Reports

Findings:

Health care quality needs to be improved, particularly for uninsured individuals who are less likely to get recommended care. Examples from findings include: - Children who had a doctor's office or clinic visit in the last 12 months whose health providers spent enough time with them was higher for children with private insurance than children with no insurance (94.5% compared with 91.5%). - Adults ages 18-64 at high risk who ever received pneumococcal vaccination was higher for adults with private insurance compared with adults with no insurance (16.8% compared with 14.2%). - Women under the age of 65 treated for breast conserving surgery who received radiation therapy within 1 year of diagnosis was higher for women with private insurance than women with no insurance (76.0% compared with 73.6%). Multivariate analyses were conducted on a number of measures of quality of care to address the interrelationships among different demographic groups and socioeconomic factors such as income and insurance. These analyses generated adjusted percentages which control for multiple factors simultaneously. In 8 of 11 regression models that focused on children or adults under age 65, uninsurance was the single strongest predictor of quality of care, exceeding the effects of race, ethnicity, income, or education. However, uninsurance did not explain all differences in care related to race, ethnicity, and socioeconomic status, suggesting that mitigating uninsurance would greatly reduce but not completely eliminate disparities in care.

Conclusions: Expanding health care coverage could improve health care quality overall for all Americans. Quality improvement and disparities reduction are achievable. Health insurance remains a key contributor to poor quality care and disparities. Data from the National Healthcare Quality Report and Disparities Report inform policymakers of the progress that has been made and the opportunities for improvement.