Hidden Costs, Value Lost Uninsurance in America (2003) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-11
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As a society, we also spend substantial public resources for health care services to the remaining 15 percent of Americans the more than 41 million people who lack coverage every year. Despite this public spending on health services for the uninsured, those who lack coverage have worse health outcomes than do similar individuals with insurance, because dollars alone do not confer the health benefits that continuous coverage does.
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but rather result from the poorer health outcomes of uninsured individuals. Families with uninsured members bear costs resulting from the financial burdens and risks of out-of-pocket health care spending and, because children's receipt of health care in practice depends on their parents' coverage status, children in families with uninsured parents are less likely to receive adequate services.
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The relative mortality rates for insured and uninsured populations were drawn from the Committee's earlier systematic literature review of health outcomes as a function of health insurance status and reflect a 25 percent higher mortality rate within the uninsured population (IOM, 2002a,b)
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HEALTH CARE COSTS OF THE UNINSURED in its analysis of the costs of health care now used by those who lack health coverage, the Committee finds that · Uninsured children and adults are less likely to incur any health care expenses in a year and, on average, incur health care costs well below half of average spending for services by all those under age 65.
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uninsured for either part of or the entire year is estimated to be $98.9 billion for 2001. · The best available estimate of the value of uncompensated health care services provided to persons who lack health insurance for some or all of a year is roughly $35 billion annually, about 2.8 percent of total national spending for personal health care services.
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Even with the considerable federal support for uncompensated care (particularly to hospitals) , when states provide health care in kind to medically indigent residents rather than through insurance programs like Medicaid and the State Children's Health Insurance Program, the costs of direct provision fall disproportionately on the local communities where care is provided (IOM, 2003a)
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Thus the Committee has identified public program and workforce impacts of health insurance status that can be inferred from related evidence about the effects of health status on disability and productivity and the effects of health insurance on health status, largely based on the Committee's reports Care Without Coverage and Health Insurance Is a Family Matter. Based on its findings and conclusions about health outcomes as a function of health insurance status in its earlier reports, the Committee concludes that public programs, including Medicare, Social Security Disability Insurance, and the criminal justice system almost certainly have higher budgetary costs than they would if the U.S.
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What evidence exists suggests that, although workers' health status may improve as a result of having coverage, individual employers probably do not lose financially, on net, as a result of impaired productivity on the job if they do not currently offer their workers health insurance benefits. Any systemic, regional, or national losses of productivity or productive capacity as a result of uninsurance among nearly one-fifth of the working-age population cannot be measured with the data now available.
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From page 9... ...
In addition, population health resources and programs, including disease surveillance, communicable disease control, emergency preparedness, and community immunization levels, have been undermined by the competing demands for public dollars for personal health care services for those without coverage. Because uninsured individuals and families are much less likely than are those who have coverage to have a regular health care provider, they are not well integrated into systems of care.
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projected cost of the additional health care that the presently uninsured population would receive if insured, and the aggregate, annualized economic value of lost health and financial security that those who lack coverage forgo, despite the substantial health care expenditures made on their behalf. The next step in the Committee's analysis is to consider the potential benefits of providing the uninsured with coverage in conjunction with the new economic costs of the additional health services that would improve their health.
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Despite the absence of an explicit Constitutional or statutory right to health care (beyond access to emergency care in hospitals, required by the Emergency Medical Treatment and Labor Act) , disparities in access to and the quality of health care of the kind that prevail between insured and uninsured Americans contravene widely accepted, democratic cultural and political norms of equal consideration and equal opportunity.
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