title: Ongoing coverage for ongoing care: access, utilization, and out-of-pocket spending among uninsured working-aged adults with chronic health care needs.
abstract: OBJECTIVE
  We sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs.
  
  
  METHODS
  We conducted multivariate analyses of the 2002-2004 Medical Expenditure Panel Survey to compare access, utilization, and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. The results are generalizable to the US community-dwelling population aged 18 to 64 years.
  
  
  RESULTS
  Among 92 million adults with chronic conditions, 21% experienced at least 1 month uninsured during the average year (2002-2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23% were uninsured during the average year. These gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use, and higher levels of out-of-pocket spending.
  
  
  CONCLUSIONS
  Implementation of health care reform must focus not only on the prevention of chronic conditions and the expansion of insurance coverage but also on the long-term stability of the coverage to be offered.
authors.affiliation: National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Building 10 CRC, Room 1-1469, 10 Center Drive, MSC 1604, Bethesda, MD 20892-1604, USA. gulley@brandeis.edu
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Gulley
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D055815:Young Adult