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Insurance doesn't guarantee follow-up care, study finds

Americans don't always get the follow-up medical care they need even if they have health insurance, say two studies that underscore the complexity of ensuring everyone has access to good care.

The research, to be published today in the Journal of the American Medical Association, looked at the role of insurance for patients who needed further medical attention after being treated for an illness or accident. While one study showed that being uninsured reduced the likelihood a person got recommended care, the other found that having insurance didn't solve the problem.

A political debate in Washington, and increasingly in state legislatures, focuses on what to do about 47 million Americans without medical coverage. The new research shows that having insurance doesn't guarantee someone can afford the care.

"We often talk about health insurance as a yes-or-no thing," said Harlan M. Krumholz, who conducted a study on follow-up care for heart attack patients, at a new conference today in Washington. "But just to get health insurance without looking at the type of coverage it entails is not enough."

Krumholz reviewed 2,498 patients recovering from heart attacks. One in five said they could not afford follow-up care, and one in eight didn't buy medicines because of the cost. More than two-thirds of those worried about costs had health insurance.

Patients who said that these "financial barriers" kept them from following doctors' orders on care after a heart attack were 30 percent more likely to end up in the hospital again, the study showed. Those who said they couldn't afford necessary medications were 50 percent more likely to require additional hospitalization.

"Is it OK for us to be living in a country where your financial circumstances are going to dictate your recovery?" said Krumholz, a professor of medicine, epidemiology, and public health at Yale University's medical school. "Or will we say this is repugnant?"

The other study, by Jack Hadley, a health economist at the Urban Institute in Washington, focused on those without health insurance. He tracked 31,000 people nationwide and found that being uninsured reduced the likelihood someone would get treatment after an injury or diagnosis of a chronic illness.

People without coverage also were less likely than those with insurance to get recommended follow-up care. In turn, they reported more often being in poorer health later on, he said.

"Health-insurance coverage is becoming a major political issue, and we know that expanding coverage is going to cost a lot," said Hadley. "I think the question is what do you get for this? This study shows there is a real health benefit."

His study found that 89 percent of people with health insurance went to the doctor after injuries such as car crashes . The percentage fell to 79 percent for those without coverage.

Nine percent of the injured people with insurance failed to get follow-up treatment recommended by a doctor, compared with 19 percent of those without coverage.

Among those with chronic diseases, such as high blood pressure, diabetes, and heart disease, 92 percent of the insured went for initial care, compared with 82 percent of those without coverage.

After this, 4.4 percent of those with coverage didn't return for more treatment, compared with 9.4 percent of the uninsured.