title: Only half the problem is being addressed: underinsurance is as big a problem as uninsurance.
abstract: This article examines the sociodemographic and health characteristics of the underinsured-people who have some health insurance but are having trouble paying for health care or medications. It uses data from the Boston Area Community Health (BACH) Survey, a large (N=5503) community-based random sample of Boston residents aged 30 to 79 years (1767 black, 1,877 Hispanic, and 1859 white; 2301 men and 3202 women). The authors found that minorities were less likely than whites to have health insurance (for men and women, respectively, 30% and 19% of Hispanics, 16% and 9% of blacks, and 9% and 7% of whites lacked health insurance). Blacks were the most likely to be underinsured (for men and women, respectively, 18% and 20% of blacks vs. 9% and 14% of Hispanics and 8% and 12% of whites were underinsured). Those of lower and middle socioeconomic status were also more likely to be uninsured or underinsured. The health status of the uninsured was similar to that of the adequately insured, whereas those who were underinsured reported more co-morbidities and depression. The underinsured are generally older and sicker, and make greater use of the health care system, and may present a larger public health and health policy challenge than the uninsured.
authors.affiliation: New England Research Institutes, Inc., Watertown, MA 02472, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Link
authors.forename: John B
authors.initials: JB
authors.lastname: McKinlay
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data; D008875:Middle Aged; D012923:Social Class
references.citation: Curr Med Res Opin. 2007 Mar;23(3):489-94
references.pmid: 17355730
references.citation: J Clin Epidemiol. 2004 Oct;57(10):1096-103
references.pmid: 15528061
references.citation: Health Aff (Millwood). 2007 Jul-Aug;26(4):w463-73
references.pmid: 17548341
references.citation: J Natl Med Assoc. 2006 Nov;98(11):1867-73
references.pmid: 17128700
references.citation: CA Cancer J Clin. 2008 Jan-Feb;58(1):9-31
references.pmid: 18096863
references.citation: Health Aff (Millwood). 2008 Jul-Aug;27(4):w285-97
references.pmid: 18522949
references.citation: Int J Health Serv. 2007;37(2):251-7
references.pmid: 17665722
references.citation: JAMA. 2007 Mar 14;297(10):1063-72
references.pmid: 17356027
references.citation: Track Rep. 2008 Sep;(21):1-5
references.pmid: 18814387
references.citation: Health Aff (Millwood). 2006 Nov-Dec;25(6):w432-43
references.pmid: 16973652
references.citation: Health Aff (Millwood). 2006 Nov-Dec;25(6):w447-9
references.pmid: 16973648
references.citation: Issue Brief (Commonw Fund). 2005 Aug;(837):1-12
references.pmid: 16092189
references.citation: J Community Health. 2008 Oct;33(5):293-6
references.pmid: 18473152
references.citation: Am J Public Health. 2009 Dec;99(12):2289-95
references.pmid: 19762659
references.citation: Int Psychogeriatr. 1999 Jun;11(2):139-48
references.pmid: 11475428
references.citation: Health Policy. 2002 Jun;60(3):201-18
references.pmid: 11965331
references.citation: Med Care Res Rev. 2000 Sep;57(3):298-318; discussion 319-25
references.pmid: 10981187
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: MedGenMed. 2000 Aug 11;2(3):E37
references.pmid: 11104483
references.citation: Am J Med. 2009 Aug;122(8):741-6
references.pmid: 19501347
references.citation: Health Aff (Millwood). 2008 Jul-Aug;27(4):w298-309
references.pmid: 18544591
references.citation: South Med J. 2009 Aug;102(8):810-3
references.pmid: 19593301
references.citation: Am J Epidemiol. 1998 May 15;147(10):969-77
references.pmid: 9596475
references.citation: Eur Urol. 2007 Aug;52(2):389-96
references.pmid: 17383808
references.citation: J Clin Epidemiol. 1993 Feb;46(2):153-62
references.pmid: 8437031
references.citation: Lancet Oncol. 2008 Mar;9(3):222-31
references.pmid: 18282806
references.citation: Ethn Dis. 2003 Winter;13(1):47-54
references.pmid: 12723012
references.citation: Stat Med. 2008 Sep 10;27(20):3927-40
references.pmid: 18680166
references.citation: BMC Public Health. 2006 Jan 24;6:14
references.pmid: 16433926
references.citation: Med Care Res Rev. 2003 Jun;60(2 Suppl):3S-75S; discussion 76S-112S
references.pmid: 12800687
references.citation: Issue Brief (Commonw Fund). 2009 Jul;62:1-16
references.pmid: 19621500
references.citation: J Womens Health (Larchmt). 2007 Sep;16(7):935-40
references.pmid: 17903070
references.citation: Public Health Rep. 1970 Sep;85(9):815-27
references.pmid: 4989476
references.citation: EBRI Issue Brief. 2007 Oct;(310):1-33
references.pmid: 17987754
references.citation: Health Serv Res. 2000 Apr;35(1 Pt 2):187-206
references.pmid: 10778809
references.citation: Mayo Clin Proc. 2005 Feb;80(2):203-10
references.pmid: 15704775
references.citation: J Natl Med Assoc. 2009 Feb;101(2):167-73
references.pmid: 19378635
references.citation: JAMA. 2007 Mar 14;297(10):1073-84
references.pmid: 17356028