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Large numbers of uninsured women in California -- the vast majority of whom work or reside in working families -- receive sporadic health care and forego important preventive services such as Pap tests and mammograms, according to a joint study by the UCLA Center for Health Policy Research and the Women's Health Collaborative.
The 175-page report, Women at Risk in California: A Chartbook on Health Insurance Coverage and Access to Care, examines access to health insurance coverage and to health care services among the state's nonelderly and elderly women.
"The majority of uninsured women have limited incomes and must make difficult choices about when to seek care," said Roberta Wyn, the report's co-author and associate director of the UCLA Center for Health Policy Research. "They are being placed at great risk by their inability to access the health care system on a regular basis."
The study found a strong connection between low income and poor health. For example, in the 45-49 age range, 40 percent of California women with incomes below the federal poverty level report being in fair to poor health, as do 29 percent of women with family incomes between 100 to 200 percent of the federal poverty level.
By contrast, just 9 percent of women ages 45-64 with family incomes at 300 percent of poverty and above report being in fair or poor health. Not coincidentally, the researchers also found a strong connection between income and insurance coverage, with more than one-third of the women who were poor (incomes below poverty) and near-poor (incomes up to twice the poverty level) lacking coverage. (At the time of the survey, the federal poverty level was about $8,000 a year for a single, nonelderly person and $16,000 for a family of four.)
Twenty-eight percent of the uninsured women delayed seeking health care within the past year because of cost concerns, while only 6 percent of insured women report delaying care for that reason. Moreover, uninsured women were found to be far more likely to forego important preventive screenings. Forty-two percent of uninsured women ages 50-64 in California have never had a mammogram, compared to 6 percent of women with employment-based or other health coverage.
The study was based on the federal 1996 Current Population Survey and the 1994 National Health Interview Survey. Funding for the project was provided by the California Endowment.
Among the study's other findings are:
The nonelderly women most likely to be uninsured in California are Latinas and Asian and Pacific Islanders; those who are noncitizen immigrants, younger, poorer, in nonworking families or in families with no member working full time for the full year; and single women, both with and without children.
Eighty-one percent of the state's uninsured women are in working families, and 45 percent of uninsured women in California are either full-time, full-year employees or in families in which a person is employed full time for the full year.
Asian and Pacific Islander women have low rates of receiving the Pap test. In the 18-45 age group, 21 percent report never being screened. Latinas and Asian and Pacific Islander women also are the least likely to have ever had a mammogram.
While 95 percent of elderly women in California have Medicare coverage, half have not had a clinical breast examination within the year prior to the study, and 60 percent have not had a mammogram in the prior year. Elderly women with private supplemental coverage are more likely than those with Medicare and Medi-Cal to have had both tests.
The UCLA Center for Health Policy Research is a part of the UCLA School of Public Health. The Women's Health Collaborative is an initiative of The James Irvine Foundation, with funding from The California Wellness Foundation and The California Endowment.