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NEUROLOGY 1996;46:1471
© 1996 American Academy of Neurology

Report of the AAN Task Force on access to health care

The effect of no personal health insurance on health care for people with neurologic disorders

Michael P. Earnest, MD, Jill M. Norris, PhD, Mark S. Eberhardt, PhD, George H. Sands, MD and The Task Force on Access to Health Care of the American Academy of Neurology*

Department of Neurology, Denver General Hospital, University of Colorado, Health Sciences Center, Denver, CO (Dr. Earnest)
Department of Neurology, University of Colorado, Health Sciences Center, Denver, CO (Dr. Earnest)
Preventive Medicine, University of Colorado, Health Sciences Center, Denver, CO (Dr. Earnest) (Dr. Norris)
Biometrics, University of Colorado, Health Sciences Center, Denver, CO (Dr. Norris)
Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Public Health Service, Hyattsville, MD (Dr. Eberhardt)
Department of Neurology, Queens Hospital Center, Mount Sinai School of Medicine, New York, NY. (Dr. Sands)

Address correspondence and reprint requests to Dr Earnest, Medical Director, Quality Review & Improvement and Department of Neurology,.Denver General Hospital, 777 Bannock Street, Denver, CO 80204.

Access to medical care is limited for people with no health insurance. In the United States, an estimated 31 to 41 million people under age 65 have no health insurance. Among the uninsured, an estimated 340,000 new cases of neurologic disorders occur annually. The Task Force on Access to Health Care of the Academy analyzed data from four nationwide health surveys to describe the national population of people with neurologic disorders (PWND) by insurance status and to examine access to care, utilization of services, and expenses for health care of PWND. Health insurance status significantly affected access to and utilization of health care services. Compared with insured PWND, the uninsured less often had a usual source of medical care, saw a particular doctor, or visited a neurologist. The uninsured had fewer doctor's office visits and fewer hospital admissions than privately insured PWND. In the doctor's office they got fewer tests, fewer referrals for therapies, but more medications. In the hospital they received more diagnostic and therapeutic procedures overall, but those with cerebrovascular disease received fewer angiograms and endarterectomies. National health care reform may improve access to care for PWND if they are equitably included in the new systems. However, neurologists should assertively advocate for the needs of PWND to have adequate insurance and appropriate access to neurologic consultations, neurologic tests, and treatments.

*See Appendix on page 1479 for Task Force participants.

Supported by a grant from the Executive Board of the American Academy of Neurology.

Presented in part in abstract form at the 45th Annual Meeting of the American Academy of Neurology, New York, New York, April, 1993.

Approved by the Executive Board of the American Academy of Neurology, July 8, 1995.

Received June 27, 1995. Accepted in final form November 1, 1995.




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