Coverage Matters Insurance and Health Care (2001) / Chapter Skim
Currently Skimming:
1. Why Health Insurance Matters
1. Why Health Insurance Matters
Pages 18-33
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From page 19... ...
Coverage Matters is the first in a series of six reports that will be issued over the next two years documenting the reality and consequences of having an estimated 40 million people in the United States without health insurance coverage. These reports will examine the implications of lacking health insurance for those without it, for their families, for communities in which a substantial number of people are uninsured, and for this country as a whole.
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From page 20... ...
Health insurance pools the risks and resources of a large group of people so that each is protected from financially disruptive medical expenses resulting from an illness, accident, or disability. In addition to serving the typical functions of risk insurance, health insurance has developed as a mechanism for financing or pre-paying a variety of health care benefits, including routine preventive services, whose use is neither rare nor unexpected.
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From page 21... ...
Government provides health insurance to populations whom the private market may not serve effectively, such as disabled and elderly persons, and populations whose access to health care is socially valued, such as children and pregnant women. The ultimate ends of health insurance coverage for the individual and communities, including workplace communities of employees and employers, are improved health outcomes and quality of life.
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From page 22... ...
Younger workers accept workplace offers of coverage more often than not, and only 4 percent of all workers between 18 and 44 years of age, i"Regular source of care" is defined as the place or provider from which one usually seeks care or advice about health care. A regular source of care may be a physician's office, a clinic, a health plan facility or a hospital emergency room or outpatient clinic.
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From page 23... ...
This obscures the link between health status and health insurance. For those without access to workplace health insurance, poor health is a potential barrier to purchasing nongroup coverage because such coverage may be highly priced, exclude preexisting conditions, or be simply unavailable.
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From page 24... ...
The decline in the number of uninsured will not continue if the economy remains slow and health care costs continue to outpace inflation. Due to the lag in measurement and reporting, however, the Census Bureau estimate of health insurance coverage for 2000 may show a further decline in the uninsured rate.
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From page 25... ...
. Still, the CPS is especially useful because it produces annual estimates relatively quickly, reporting the previous year's insurance coverage estimates each September, and because it is the basis for a consistent set of estimates for more than 20 years, allowing for analysis of trends in coverage over time.
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From page 26... ...
Although the relationship between health insurance and health outcomes is neither direct nor simple, an extensive clinical and health services research literature links health insurance coverage to improved access to care, better quality, and improved personal and population health status. The Committee's conceptual framework for considering the extent and nature of these and additional effects of health insurance builds selectively upon the most widely used behavioral model of access to health services (Andersen, 1995; Andersen and Davidson 2001~.
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From page 27... ...
While the effects of lacking health insurance on access to care and thus potentially on health may not be apparent for those who are uninsured only briefly, even short periods without insurance entail a measure of financial risk to self and family of incurring high expenses for health care. The Committee does not attempt to address the condition of"underinsurance." By the "underinsured" is meant individuals or families whose health insurance policy or benefits plan offers less than adequate coverage.
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From page 28... ...
Formal research about uninsured populations in the United States dates to the late 1920s and early 1930s when the Committee on the Cost of Medical Care produced a series of reports about financing physician office visits and hospitalizations. This issue became salient as the numbers of medically indigent climbed during the Great Depression.
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From page 29... ...
Since the enactment of Medicare and Medicaid, health services research on uninsured populations has been sponsored federally and privately, at increasing levels of support over time and using new survey tools and data sets (Somers and Somers, 1961; Numbers, 1979; Starr, 1982; Andersen and Anderson, 1999~. The Census Bureau started collecting detailed information about health insurance in the latter half of the 1970s and the National Center for Health Services Research, a predecessor to AHRQ, conducted the National Medical Care Expenditure Survey (NMCES)
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From page 30... ...
, even after adjusting for differences in age, sex, income, and health status, uninsured people were less than half as likely as insured persons to receive care for a condition that physicians deemed highly serious and requiring medical attention. People without insurance are also less likely than people with insurance to receive preventive services and appropriate routine care for chronic conditions, even as the importance of preventive care and the prevalence of chronic disease become more prominent elements within health care (HaLner-Eaton, 1993; Ayanian et al., 2000; Institute of Medicine, 2001~.
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From page 31... ...
In rural areas, for instance, the mix of safety-net providers tends to feature private physicians and health centers or clinics, whereas urban areas are more likely to be served by teaching hospitals (Schur and Franco, 1999~. In addition to those providers whose patient populations include substantial proportions of uninsured persons, in the aggregate, private physicians, community hospitals, and teaching hospitals affiliated with academic health centers provide significant amounts of care to uninsured patients (Cunningham and Tu, 1997; Mann et al., 1997; Institute of Medicine, 2000~.
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From page 32... ...
What are the probabilities for specific popula4The federal Emergency Medical Treatment and Active Labor Act, part of the Consolidated Omnibus Budget Reconciliation Act of 1985, requires hospital emergency rooms to assess and stabilize all patients with a life- or limb-threatening or emergency medical condition or those who are about to give birth. Hospitals are not required to provide continuing care after the patient has been stabilized and transferred or released.
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From page 33... ...
In addition to characterizing the likelihood of being uninsured in terms of a single dimension, such as gender, age, race, work status, or geographic region, Chapter 3 also presents the results of multivariate analyses that offer a more informative depiction of the factors that contribute to the chances of being uninsured. Finally, in Chapter 4 the Committee presents the research agenda for its overall project and previews the five future reports.
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