Skip to main content

Currently Skimming:

5 Community Health and Uninsurance
Pages 138-161

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 138...
... The intentional dispersal of anthrax through the U.S. mail in late 2001 revealed yet another way in which uninsurance could threaten community health, when the impaired access to care of uninsured persons means delays in detecting, treating, and monitoring the transmission of infectious disease linked to bioterrorism (Wynia and Gostin, 2002; IOM, forthcoming 2003~.
From page 139...
... As will be described in the pages that follow, unin-surance is also hypothesized to result in greater financial strains on state and local health departments, strains that may lead to the shifting of discretionary funds from population-based public health activities to the delivery of personal health services and cost-cutting measures such as the trimming of staff. Both types of responses weaken the ability of local health departments to respond to emergencies, particularly involving the spread of communicable diseases.
From page 140...
... GEOG12APHIC AND SOCIOECONOMIC DISPARITIES IN HEALTH Finding: Measured across states and metropolitan areas, persons from lower-income families, nearly one-third of whom are uninsured, are more likely to report fair or poor health status in areas with high uninsured rates. Finding: Hospitalization rates for conditions amenable to early treatment on an ambulatory basis are higher in communities that include greater proportions of lower-income and uninsured residents, indicating both access problems and greater severity of illness.
From page 141...
... The studies that the Committee reviews in the discussion that follows do not include analytic adjustments allowing distinctions to be made among the relative influence on health-related outcomes of coverage status, income level, and other major covariates of uninsured rate. While the studies do not allow for the tracing of a definitive pathway for community effects, the Committee finds that the sheer number of uninsured persons in an area adds to the overall burden of disease and disability, as measured by self-reported health status and the number of preventable hospitalizations.
From page 142...
... . For urban, suburban, and nonmetropolitan communities across the country, uninsured rates also correlate with the relative health status reported by residents.
From page 143...
... In addition, timely and adequate care for uninsured residents could lead to offsetting reductions in the demands on the resources of community facilities and public budgets that currently provide hospital care. PUBLIC HEALTH AND COMMUNITY UN IN S U12ANCE Finding: Because areas with relatively high uninsured rates are likely to have greater burdens of disability and disease, their needs for
From page 144...
... About a third of local health departments surveyed in the early 1990s reported that they offered general primary care services (NACCHO, 2001~. A more recent survey finds that more than one-quarter of local health departments serve as the only safety-net provider in their community (Keane et al., 2001 a)
From page 145...
... In response to the infusion of federal Medicaid dollars for these services during the 1980s, states cut back or simply did not increase their direct support of health department activities. With the loss in the 1990s offee-for-service reimbursements for these health department services consequent to Medicaid managed care contracts with private health plans for EPSDT services, together with cuts in real-dollar terms in their budgets, local health departments have been pressed to reduce their level of service provision (Ormond and Lutzky, 2001; IOM, forthcoming 2003~.
From page 146...
... A survey of a random sample of local health department directors, stratified by the size of their jurisdiction, finds that a majority believe that their uninsured constituents cannot rely on privatized services alone and that the directors do not see themselves as able to promote quality of or access to care for privatized services (Keane et al., 2001a)
From page 147...
... The incidence and prevalence of vaccine-preventable and communicable diseases are expected to be higher in areas with high uninsured rates where health departments have been chronically short of funding. In the following discussion of childhood immunization and communicable diseases (including STDs, HIV/AIDS, and TB)
From page 148...
... The completely federally financed Vaccines for Children (VFC) program provides childhood vaccines free to private primary care practitioners, federally qualified health centers, and public clinics for administration to uninsured children, Medicaid-eligible children, and in clinical settings, children whose private insurance does not cover immunizations (IOM, 2000~.
From page 149...
... Although VFC is an important programmatic improvement in securing the immunization of uninsured children, achieving childhood immunization goals is facilitated when children have public or private health insurance. Insurance increases the likelihood that children will have a regular source of care and receive routine preventive services (IOM, 2002b)
From page 150...
... If funding for local health department specialty services (e.g., STD clinics, family planning) is reduced because of mandated priorities or when other claims on public budgets take precedence (such as the state share of Medicaid program costs or public hospital operations)
From page 152...
... For uninsured persons, the key site of care for STDs is the local health department STD clinic. Other sites for care include other community-based clinics (e.g., community health centers, family planning clinics, school health centers)
From page 153...
... STD clinics function in a safety-net capacity, providing a high volume of care and much of the specialized care (e.g., screening, contact tracing and notification of partners who may have been infected by a patient, short-term treatment) for these diseases nationally and serving patients who seek privacy or have difficulties gaining access to care because they are uninsured or because there are no knowledgeable local providers (Eng and Butler, 1997~.
From page 154...
... Although uninsured persons can and do obtain care from community health centers, academic medical centers, public hospitals, and other providers that participate in safety-net arrangements, effective treatment of HIV, to lower the chances that a person will develop AIDS, requires regular care and coordination of care across providers, both of which are more difficult to do in
From page 155...
... States vary in how they use Ryan White funds, so the experiences of uninsured persons in obtaining access to screening and therapy for HIV-positive status depend on how the funds are allocated within states according to priorities set by planning councils and the state. In the case of prescription drug benefits under Title II of the Ryan White CARE Act (AIDS Drug Assistance Programs)
From page 156...
... In this way, immigrant communities with high uninsured rates can experience
From page 157...
... Poverty rates are high, and the rapid economic and population growth has not been matched by increases in public or private health care services capacity (Pinkerton, 2002~. Uninsured rates in border counties range between 25 and 35 percent and are believed to be even higher among residents of semirural colonial, where one survey put the uninsured rate at 64 percent (Pinkerton, 2002~.
From page 158...
... between reported cases of TB and uninsured rates is likely to be overstated due to the presence of unmeasured covariates with uninsured rate.5 Even if this substantial correlation does not support the conclusion that uninsurance 5see Table c.5 in Appendix c for the uninsured and TB case rates used in this figure.
From page 159...
... The Committee's findings about the likely reduced access to hospital emergency medical services and trauma care in areas with high uninsured rates allude to a related community effect, emergency preparedness. Our nation's capability to respond to casualties on a broad scale, including bioterrorism, is a function of its public health capacity, which depends on adequate and consistent funding for public health activities and health departments at the state and local level nationally.
From page 160...
... In view of the increasing demands being placed upon state and local health departments in the areas of emergency preparedness and disease surveillance in the context of bioterrorism, the need for such information is urgent. 5.2 Population Health (Burden of Diseased, Including Spillover Effects of Communicable and Chronic Diseases Does the local uninsured rate, independent of other factors, influence the spread or prevalence of communicable diseases?
From page 161...
... Because detailed local health status, health outcomes, and insurance coverage data are not available together, or available for enough localities to discern differences among them that could be attributed to the extent of local uninsurance, these findings are qualitative and suggestive rather than definitive.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.