Hidden Costs, Value Lost Uninsurance in America (2003) / Chapter Skim
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5. The Cost of the Additional Care That the Uninsured Would Use If They Had Insurance Coverage
5. The Cost of the Additional Care That the Uninsured Would Use If They Had Insurance Coverage
Pages 95-104
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From page 95... ...
Insurance improves the health and wellbeing of the insured by increasing access to preventive services, timely care, and medical treatment. This chapter presents benchmark estimates of the additional monetary cost of the health care that those without coverage would be expected to use if they had coverage.
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From page 96... ...
This assumption may not hold in those localities with particularly large uninsured populations and limited health care delivery resources. In any case, estimates of inflation in health care prices would depend on the particular features of a proposed health care reform, including any explicit cost control elements.
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From page 97... ...
This amount represented 2.2 percent oftotal national spending for health care in 1993. Adjusting the estimates for the difference in the number of uninsured in 2001 and in 1993, the estimate grows to $35 billion, assuming no differences in the mix of demographic, health, and socioeconomic characteristics of the uninsured between the late 1980s and 2001.
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From page 98... ...
From these models, the authors estimated the cost of expanding coverage to each of four subgroups of the uninsured: full-year uninsured, who either had or did not have an offer or eligibility for coverage, and part-year uninsured, who either had coverage for less than 6 months or for 6 through 11 months. Expenditures for those uninsured for part of the year only, who started off with much higher annual health care spending, increased much less over the baseline, ranging from a 3 percent decrease in spending for those uninsured for less than 6 months assuming Medicaid coverage, to a 58 percent increase in baseline spending for those uninsured 6 months or more, assuming private coverage.
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From page 99... ...
The estimated incremental health expenditures for all groups of the uninsured, assuming a pattern of utilization and spending that matched the average of all group private insurance, range from $44.9 to $57.4 billion for 2002 and, assuming utilization and spending comparable to the national average per capita Medicaid experience, range from $35.1 to $38.1 billion. These estimates deduct the estimated value of in-kind uncompensated care (that is, uncompensated care for which no revenue support stream can be identified)
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From page 100... ...
They inflated the expenditures to 2001 levels and adjusted for undercounting of uncompensated care in MEPS using National Health Accounts statistics. Unlike the analysis by Miller and colleagues, Hadley and Holahan limited their sample of privately insured people to those with family incomes less than 400 percent of the federal poverty line.
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From page 101... ...
This analysis accounted for the length of time those who were uninsured during the year had any public or private insurance coverage, demographic characteristics (including age, race, sex) , education, family income relative to poverty, marital status, and census region, and health-related characteristics including health status, mental health status, functional status, acute and chronic conditions, and whether the respondent died or was institutionalized during the year.
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From page 102... ...
They range from an 8 percent increase for partyear uninsured children based on Medicaid experience to a 49 percent increase for adults uninsured for part of the year if they had the average private group experience. Overall, health care expenditures for individuals uninsured for any amount of time during the year are projected to increase to $132.8 billion, 134 percent ofthe baseline of $98.9 billion in 2001, if their utilization and spending followed the experience ofthose with Medicaid coverage, and to $167.6 billion, 170 percent of baseline, if at average private group insurance levels.
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From page 103... ...
The Long and Marquis estimates are based on differences in visit rates and hospital days per capita, assuming that there are no differences in the cost per visit or the cost per inpatient day between the insured and uninsured. The two studies that used much more current data from the MEPS differed from the earlier analysis by Marquis and Long in that they looked directly at health care expenditures (including uncompensated care)
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From page 104... ...
This amounts to a 2.8 to 5.6 percent increase in spending for personal health care services for 2001. It is equivalent to between one-third and two-thirds of the 8.7 percent growth in national expenditures for personal health care services between 2000 and 2001 (Levis et al., 2003~.
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