Brief Report Loss of Health Insurance and the Risk for a Decline in Self-Reported Health and Physical Functioning DAVID W. BAKER, MD, MPH,* † JOSEPH J. SUDANO,PHD,* JEFFREY M. ALBERT,PHD, † ELAINE A. BORAWSKI,PHD, † AND AVI DOR,PHD ‡ BACKGROUND. Millions of Americans are in- termittently uninsured. The health conse- quences of this are not known. SETTING. National survey. PARTICIPANTS. Six thousand seventy-two par- ticipants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992. MEASUREMENTS. Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new phys- ical difficulty between 1994 and 1996. RESULTS. In 1994, 5768 (95.0%) people continued to have private insurance, 229 (3.8%) reported hav- ing lost all insurance, and 75 (1.2%) converted to having only public insurance. Over the subse- quent 2 years (1994 –1996), the risk for a major decline in overall health was 15.6% for those who lost all insurance versus 7.2% for those with con- tinuous private insurance ( P <0.001). After adjust- ing for baseline sociodemographics, health behav- iors, and health status, the adjusted relative risk for a major decline in health for those who lost cover- age was 1.82 (95% CI, 1.25–2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5% vs. 20.4%, respectively; P  0.02), but this was not significant in multivariate analysis (adjust- ed RR, 1.26; 95% CI, 0.90 –1.68). CONCLUSIONS. Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance cov- erage should routinely measure the number of Americans uninsured at any time over the pre- ceding 2 years as a more accurate measure of the population at risk from being uninsured. Key words: Medically uninsured; insurance coverage; health services accessibility; health status; outcome assessment. (Med Care 2002; 40:1126 –1131) Insurance coverage for adults in late middle-age is a major health policy concern. 1–4 We previously reported that people age 51 to 61 years who were continuously uninsured were more likely to have a decline in overall health and physical functioning than individuals with private insurance. 5 Individ- uals who were intermittently uninsured were also at increased risk for adverse health outcomes, which is consistent with reports that the intermit- tently uninsured face access barriers. 6–8 However, *From the Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio. † From the Department of Epidemiology and Biosta- tistics, Case Western Reserve University School of Med- icine, Cleveland, Ohio. ‡ From the Department of Economics, Case Western Reserve University, Cleveland, Ohio. Supported by grant number by grant number R01 HS10283-01 from the Agency for Healthcare Research and Quality (AHRQ). Address all correspondence and requests for reprints to: David W. Baker, MD, MPH, MetroHealth Medical Center, 2500 MetroHealth Drive, Rammelkamp 221, Cleveland, OH 44109-1998. E-mail: dwb@po.cwru.edu Received November 27, 2001; initial review February 6, 2002; accepted 2, 2002. DOI: 10.1097/01.MLR.0000032192.46564.16 MEDICAL CARE Volume 40, Number 11, pp 1126–1131 ©2002 Lippincott Williams & Wilkins, Inc. 1126