ReviewThe Milbank quarterly2009
Health consequences of uninsurance among adults in the United States: recent evidence and implications.
Review in The Milbank quarterly, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 142 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
142 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses.PLoS medicine · 2020Pooled it
- Trial
- Health Promotion Programs and Policies in the Workplace: An Exploratory Study With Alaska Businesses.Preventing chronic disease · 2020Trial
- Health insurance status is associated with periodontal disease progression among Gullah African-Americans with type 2 diabetes mellitus.Journal of public health dentistry · 2011Trial
- Unstable hours, unequal health: Gendered occupational health costs of work-hour volatility in the U.S.SSM - population health · 2026Article
- Overcoming social determinants: World trade center health program monitoring use among the general responders.Preventive medicine reports · 2026Article
- Identifying Social Need Trends Among Emergency Department Super-Users: A Latent Class Analysis.The western journal of emergency medicine · 2026Article
- Large-scale assessment of socioeconomic, demographic and health system structures with US county excess mortality, 2020-2024.medRxiv : the preprint server for health sciences · 2026Article
- When Being Hispanic Isn't Enough: Intersectional Race-Sex Inequalities in Functional Limitations Among Immigrants.Journal of racial and ethnic health disparities · 2026Article
- Alleviating Costs for Critical Eye Specialty Services (ACCESS): a prospective cohort analysis of a cost-coverage program at a public safety-net hospital.Lancet regional health. Americas · 2026Review
- Enrolled and unaware: characteristics of Medicaid enrollees misreporting their coverage Status.Health affairs scholar · 2026Article
- Fragmentation in health system financing: a major challenge for improving effectiveness, efficiency, equity and choice within health systems.BMJ public health · 2026Review
- Quality of care and health insurance uptake in Namibia.Journal of public health in Africa · 2026Article
- Duration of health insurance coverage gaps and subsequent cost-related barriers to care among adults aged 18-64 years with multimorbidity.Frontiers in public health · 2026Article
- Predictors and Consequences of Poor Health Trajectories Among US Adults Ages 50-64: A Latent Class Growth Analysis.Journal of general internal medicine · 2026Article
- Development of machine learning models to predict risk of hospitalisation and 90-day readmission among patients with cardiovascular risk factors using community health survey data.BMJ health & care informatics · 2025Article
- Patient Healthcare Seeking If There Were No Limits.Journal of the American Board of Family Medicine : JABFM · 2025Article
- Racial/Ethnic variation in health insurance coverage and early midlife depressive symptoms in the U.S.BMC health services research · 2025Article
- The Impact of Coronavirus Disease 2019 (COVID-19) on Vulnerable Communities: What the Clinician Should Know.Infectious disease clinics of North America · 2025Review
- The Role of County-Level Persistent Poverty in Stroke Mortality in the USA.Journal of racial and ethnic health disparities · 2025Article
82 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextUninsured adults have less access to recommended care, receive poorer quality of care, and experience worse health outcomes than insured adults do. The potential health benefits of expanding insurance coverage for these adults may provide a strong rationale for reform. However, evidence of the adverse health effects of uninsurance has been largely based on observational studies with designs that do not support causal conclusions. Although recent research using more rigorous methods may offer a better understanding of this important subject, it has not been comprehensively reviewed.
methodsThe clinical and economic literature since 2002 was systematically searched. New research contributions were reviewed and evaluated based on their methodological strength. Because the effectiveness of medical care varies considerably by clinical risk and across conditions, the consistency of study findings with clinical expectations was considered in their interpretation. Updated conclusions were formulated from the current body of research.
findingsThe quality of research has improved significantly, as investigators have employed quasi-experimental designs with increasing frequency to address limitations of earlier research. Recent studies have found consistently positive and often significant effects of health insurance coverage on health across a range of outcomes. In particular, significant benefits of coverage have now been robustly demonstrated for adults with acute or chronic conditions for which there are effective treatments.
conclusionsBased on the evidence to date, the health consequences of uninsurance are real, vary in magnitude in a clinically consistent manner, strengthen the argument for universal coverage in the United States, and underscore the importance of evidence-based determinations in providing health care to a diverse population of adults.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.