Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Primary Care Medicine


Professor Nancy E. Reid, MHA, DHSc, PA-C




This manuscript examines the literature evidence that being uninsured is an independent risk factor for poor health in the US.


A literature search was conducted through PubMed and MedLine using the search terms: uninsured, underinsured, risk factor, poor health. The search results identified 245 articles. The search was repeated adding the search term: Medicaid. The search results reduced the number of articles to 55. These results were filtered to include articles published within the past 5 years and the yield was 30 articles. Five articles of pertinent original source material published greater than 5 years ago were retained. Articles not directly relevant to the US medical environment were excluded and the remaining 21 articles were included in this review.


The evidence reviewed here demonstrates a definitive association between being uninsured and poorer health outcomes. This review finds that being uninsured is an evidence-based risk factor for poorer health.


Without insurance, an individual is at risk for significantly fewer cancer screenings leading to more advanced disease and reduced survival rates with a cancer diagnosis. Changing from an uninsured status to an insured status has rapid, dramatic, and positive outcomes in application of screening tests and in self-appraisal of well-being. These positive changes are seen promptly with the ending of the uninsured status.

This review finds that being uninsured is an evidence-based risk factor for poorer health. Knowing this risk factor, providers and their professional associations have the societal responsibility to support amelioration of it. Supporting and facilitating universal healthcare – through a single source or through multiple sources – ends this risk factor in America.


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