About 16 million U.S. adults are underinsured and often go without needed medical services, medications and follow-up care, primarily because of the associated costs, according to a study published Monday on the Health Affairs Web site, the Chicago Tribune reports. The study defines the underinsured as those whose medical expenses account for at least 10% of their income, or, among low-income U.S. residents, 5% of their income. Almost three out of four underinsured U.S. adults are considered low-income, the study finds. People with high deductibles and coverage limitations also can be considered underinsured, the Tribune reports. According to the study, 38% of those who are underinsured often choose not to fill prescriptions; 32% decide not to see a doctor even when they have a medical problem; 30% avoid medical tests, treatment or follow-up care; and 18% decline care from specialists, primarily because the services are too costly. The underinsured also have trouble paying their medical bills compared with people who have comprehensive insurance plans. Forty-six percent of people with more limited coverage report being contacted by a collection agency regarding unpaid medical bills, and 35% said they have had to change their lifestyle to cover medical expenses, the study says. People who have no health coverage are reported to show similar behavior to the underinsured, the Tribune reports. Lead author Cathy Schoen, vice president of the Commonwealth Fund, said that in the near future, "it could become harder to differentiate consumers who are underinsured from those who are uninsured." If the trend continues, as expected, "the number of the underinsured [will] grow enormously in the years ahead," and people who are sick will be disproportionately affected, Ron Pollack, executive director of Families USA, said. Pollack added that low-cost, high-deductible plans such as health savings accounts could contribute to the problem if consumers do not have the financial means to pay for services in advance. Susan Pisano, a spokesperson for America's Health Insurance Plans, said, "Choice of products is a good thing," adding, "These options won't work for everyone, but they do address real needs in the market" (Graham, Chicago Tribune, 6/14).

An abstract of this study is available online.