HEALTH CARE FALLS SHORT FOR 1 IN 3.(MAIN)

Byline: ROBERT PEAR New York Times

WASHINGTON -- A new study by researchers at the Harvard School of Public Health says that 31 percent of Americans were without health insurance or had difficulty getting or paying for medical care at some time in the last year.

``Problems in getting needed medical care affect about 17 million uninsured adults and 17 million insured adults in America,'' the researchers said. ``Problems in paying medical bills are reported by 13 million uninsured and 17 million insured Americans.''

The study, announced Tuesday and published today in The Journal of the American Medical Association, involved telephone interviews with about 4,000 Americans selected at random.

The researchers, led by Karen Donelan and Prof. Robert J. Blendon at Harvard, found that 45 percent of the uninsured and 11 percent of those with health insurance said they needed care and could not get it at some time in the year before the survey.

Donelan, the principal author of the study, said: ``The sickest people surveyed are most likely to have problems getting the medical care they need. The vast majority of uninsured adults in poor health had difficulty getting care. This contradicts the conventional wisdom that truly sick people can always get care when they need it.''

``Seventy percent of the uninsured said that their symptoms were either `very serious' or `somewhat serious' at the time they could not get care,'' the authors said.

The Harvard study, financed with a grant from the Henry J. Kaiser Family Foundation, said, ``It is a commonly held assumption that the uninsured can get free or charity care if they need it.''

But the researchers found that ``only 37 percent of the uninsured who reported problems in paying medical bills said that they had received medical care for free or for a reduced charge in the previous year.''

Overall, the study said, 37 million adults reported that they were uninsured at the time of the survey in 1995 or at some time in the prior year. ``Fifty-three percent of uninsured adults reported problems getting or paying for health care in the previous year, with 17 million adults saying these problems had serious consequences'' for their physical or mental health, family relationships, employment or household finances, the authors reported.

``Cost and the lack of employer-provided coverage are the principal reasons for being uninsured,'' the study said, adding that very few people are uninsured by choice.

About 70 percent of the uninsured said they had been employed some of the time they were without health insurance. Many said they had worked for employers who provided coverage to at least some employees.

Other research suggests that the number of uninsured Americans has increased in recent years as employers cut back coverage for employees and hire more part-time workers without health benefits.

In September, the American Hospital Association said that employer-sponsored health insurance coverage had steadily eroded in recent years, even though many employers were able to control health costs through greater use of health maintenance organizations and other forms of managed care.

Jack A. Meyer, president of the Economic and Social Research Institute, a non-profit research organization in Washington, documented the changes in a recent survey examining 600 businesses of various sizes. ``In the name of cost control,'' he said, ``some employers are dropping coverage altogether.''

Other businesses continue to provide health insurance for employees, but are reducing or eliminating their contributions toward the coverage of employees' family members, Meyer said.

Four of 10 employers said they would prefer to pay just 50 percent or less of the cost of their workers' health insurance premiums, Meyer found.