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HEALTH INSURANCE IN THE U.S.A.
259
Annotations
accepting a permanent reduction in their standard living.5 Even when a family has quite wide insurance protection, a major illness can still bring real hardship and even penury. Voluntary health insurance is not the complete answer. President Johnson’s health message to Congress on Jan. 7 proposed valuable supplements (see p. 260) which will improve health cover, especially sions,
or
of
HEALTH INSURANCE IN THE U.S.A.
A CONSORTIUM of eight insurance companies representing 90% of profit-making insurance business in the United States has reviewed1 the extent of health insurance cover in the country. At the close of 1963 over 145 million of such vulnerable groups as the old and the young. But Americans (77% of the civilian population) had protec- they still will net enjoy the firm shelter which the National tion against hospital expenses (i.e., room-and-board Health Service gives to all British citizens. charges and drugs and dressings in hospital) and 72% were also insured against surgeons’ fees. 55% had cover THE CONTAMINATED DROP against fees of physicians, radiologists, pathologists and while others, they were undergoing inpatient treatment; CONSIDERING how constantly the warm and moist surand 23% took out policies to give protection against the face of the eye is exposed to the mass of organisms in the heavy, or even financially crippling, expenses of pro- air, it is perhaps remarkable that it is not infected more longed illness or injury (major medical expense insurance). often. Credit must largely be given to the bactericidal One of the objects of the report is to’demonstrate how action of the tears. The conjunctiva, with its ready vascuhealth insurance has grown both in numbers covered and lar response to irritation, is well provided with an additional in depth of cover. Health insurance of this kind had its defence mechanism; but the situation of the cornea seems beginnings only about thirty years ago with the non- to be less secure, and certain organisms (notably Pseudoprofit-making Blue Cross plan, which was followed by monas aeruginosa, Streptococcus pneumonia, Neisseria Blue Shield. The commercial insurance companies were gonorrhaeae, Strep. pyogenes, and Staphylococcus aureus) in the field soon afterwards, but by 1940 only 9%of have a particular facility in penetrating it. The role of America’s population had any form of health insurance.l minute abrasions in corneal and intraocular infections Since then growth has been spectacular both in numbers from these and other more innocuous organisms is far insured and in the kind of medical risks covered. In the from when of but the hazard a clear; wound-surgical U.S.A. health insurance is offered a la carte, the amount or traumatic-is introduced, the threat of serious damage and nature of cover being determined by what the policy- is grave. Such infections, in their early stages at least, are holder feels he can afford. readily controlled by antibacterial drugs in high concenIf group insurance can be arranged, the companies can tration, and the wide range of antibiotics and sulphonaoffer lower premiums, because the cost of selling policies mides has greatly reduced the dangers from chance and of collecting premiums is substantially reduced. inoculation. Doubtless for this reason, in densely populated industrial Topical applications, however, can carry their own States like New York, Illinois, Michigan, and Pennsyl- risks if they are not sterile. The danger is greatest when vania, health insurance coverage is at its highest. But an eye-drops are used (as they must be) during and after official reportshowed that persons of all ages in the operations; and the need for constant scrutiny of the lowest income group-especially children (only 22°,% of methods used in their preparation has been emphasised.6 whom have hospital cover)-and people over 65 years of Moreover, experience in Birmingham has lately underage in all income groups (those who need it most) have lined the need for vigilance.’The control of drops for outthe least insurance cover because they cannot afford it. patient treatment is less straightforward, because the mainTo readers in Great Britain, who are by now accus- tenance of asepsis in their use and the prevention of casual tomed to a comprehensive health service, the American contamination of the opened bottle are much more difficult. report is more interesting for its omissions than for its The most important safety measure for eye-drops is assertions. A superficial reading might convey the idea satisfactory sterilisation, if possible in the container in that more than three-quarters of America’s population which they are to be dispensed, and the requirements of need have no worries about the cost of sickness or injury. the British Pharmaceutical Codex, 1963, provide the means. But this is far from so. Although slightly more than In so far as drugs which can be autoclaved are concerned, three-quarters of the population have some insurance the efficacy of these precautions is at present limited by cover, only just over a quarter of what the American the inability of available bottles to withstand this process; citizen spends on personal health services is met out of but this problem is approaching solution. Extra protection insurance funds.3 The expenses of treatment in hospital against contamination once the container has been opened are only met in part, and there is little protection at all is evidently needed. Single-dose containers are ideal, against the cost of doctors’ fees in the home or consulting- and are being increasingly used in hospitals, though room, dental care, nursing services, or drugs.4 Mental elsewhere they have found few applications. and emotional illnesses are specifically, and usually totally, The choice of a preservative presents difficulties, excluded from policies.3 because, for one thing, so great a variety of medicaments The cost of medical care in the United States (as elseare applied to the eye. Ideally, it should -be effective where) is steadily rising, more rapidly indeed than the against a wide range of organisms (and particularly general cost of living; and many Americans are unable to against the most dangerous common contaminant, meet it without running into debt, selling their possesPs. aeruginosa); it must be non-irritant to the superficial 1. The Extent of Voluntary Health Insurance Coverage in the United tissues and harmless if absorbed into the eye; it must be States as of Dec. 31, 1963. Pp. 32. Free, from Editorial Division, Health Insurance Council, 277, Park Avenue, New York, 17. compatible with the medicament dispensed ; and it must 2. Medical Care, Health Status and Family Income. Public Health Service Publication no. 1000, Series 10, no. 9, 1964. Washington, D.C. 3. Evang, K., Murray, D. S., Lear, W. J. Medical Care and Family Security. Englewood Cliffs, New Jersey, 1963. 4. Abel-Smith, B. Paying for Health Services. World Health Organisation, Geneva, 1963.
5. 6. 7.
Anderson, O. W., Colette, P., Feldman, J. J. Changes in Family Medical Care Expenditures and Voluntary Health Insurance. Cambridge, Mass, 1963. Ridley, F. Brit. J. Ophthal. 1958, 42, 641. See Lancet, 1964, ii, 1797.
Annotations
accepting a permanent reduction in their standard living.5 Even when a family has quite wide insurance protection, a major illness can still bring real hardship and even penury. Voluntary health insurance is not the complete answer. President Johnson’s health message to Congress on Jan. 7 proposed valuable supplements (see p. 260) which will improve health cover, especially sions,
or
of
HEALTH INSURANCE IN THE U.S.A.
A CONSORTIUM of eight insurance companies representing 90% of profit-making insurance business in the United States has reviewed1 the extent of health insurance cover in the country. At the close of 1963 over 145 million of such vulnerable groups as the old and the young. But Americans (77% of the civilian population) had protec- they still will net enjoy the firm shelter which the National tion against hospital expenses (i.e., room-and-board Health Service gives to all British citizens. charges and drugs and dressings in hospital) and 72% were also insured against surgeons’ fees. 55% had cover THE CONTAMINATED DROP against fees of physicians, radiologists, pathologists and while others, they were undergoing inpatient treatment; CONSIDERING how constantly the warm and moist surand 23% took out policies to give protection against the face of the eye is exposed to the mass of organisms in the heavy, or even financially crippling, expenses of pro- air, it is perhaps remarkable that it is not infected more longed illness or injury (major medical expense insurance). often. Credit must largely be given to the bactericidal One of the objects of the report is to’demonstrate how action of the tears. The conjunctiva, with its ready vascuhealth insurance has grown both in numbers covered and lar response to irritation, is well provided with an additional in depth of cover. Health insurance of this kind had its defence mechanism; but the situation of the cornea seems beginnings only about thirty years ago with the non- to be less secure, and certain organisms (notably Pseudoprofit-making Blue Cross plan, which was followed by monas aeruginosa, Streptococcus pneumonia, Neisseria Blue Shield. The commercial insurance companies were gonorrhaeae, Strep. pyogenes, and Staphylococcus aureus) in the field soon afterwards, but by 1940 only 9%of have a particular facility in penetrating it. The role of America’s population had any form of health insurance.l minute abrasions in corneal and intraocular infections Since then growth has been spectacular both in numbers from these and other more innocuous organisms is far insured and in the kind of medical risks covered. In the from when of but the hazard a clear; wound-surgical U.S.A. health insurance is offered a la carte, the amount or traumatic-is introduced, the threat of serious damage and nature of cover being determined by what the policy- is grave. Such infections, in their early stages at least, are holder feels he can afford. readily controlled by antibacterial drugs in high concenIf group insurance can be arranged, the companies can tration, and the wide range of antibiotics and sulphonaoffer lower premiums, because the cost of selling policies mides has greatly reduced the dangers from chance and of collecting premiums is substantially reduced. inoculation. Doubtless for this reason, in densely populated industrial Topical applications, however, can carry their own States like New York, Illinois, Michigan, and Pennsyl- risks if they are not sterile. The danger is greatest when vania, health insurance coverage is at its highest. But an eye-drops are used (as they must be) during and after official reportshowed that persons of all ages in the operations; and the need for constant scrutiny of the lowest income group-especially children (only 22°,% of methods used in their preparation has been emphasised.6 whom have hospital cover)-and people over 65 years of Moreover, experience in Birmingham has lately underage in all income groups (those who need it most) have lined the need for vigilance.’The control of drops for outthe least insurance cover because they cannot afford it. patient treatment is less straightforward, because the mainTo readers in Great Britain, who are by now accus- tenance of asepsis in their use and the prevention of casual tomed to a comprehensive health service, the American contamination of the opened bottle are much more difficult. report is more interesting for its omissions than for its The most important safety measure for eye-drops is assertions. A superficial reading might convey the idea satisfactory sterilisation, if possible in the container in that more than three-quarters of America’s population which they are to be dispensed, and the requirements of need have no worries about the cost of sickness or injury. the British Pharmaceutical Codex, 1963, provide the means. But this is far from so. Although slightly more than In so far as drugs which can be autoclaved are concerned, three-quarters of the population have some insurance the efficacy of these precautions is at present limited by cover, only just over a quarter of what the American the inability of available bottles to withstand this process; citizen spends on personal health services is met out of but this problem is approaching solution. Extra protection insurance funds.3 The expenses of treatment in hospital against contamination once the container has been opened are only met in part, and there is little protection at all is evidently needed. Single-dose containers are ideal, against the cost of doctors’ fees in the home or consulting- and are being increasingly used in hospitals, though room, dental care, nursing services, or drugs.4 Mental elsewhere they have found few applications. and emotional illnesses are specifically, and usually totally, The choice of a preservative presents difficulties, excluded from policies.3 because, for one thing, so great a variety of medicaments The cost of medical care in the United States (as elseare applied to the eye. Ideally, it should -be effective where) is steadily rising, more rapidly indeed than the against a wide range of organisms (and particularly general cost of living; and many Americans are unable to against the most dangerous common contaminant, meet it without running into debt, selling their possesPs. aeruginosa); it must be non-irritant to the superficial 1. The Extent of Voluntary Health Insurance Coverage in the United tissues and harmless if absorbed into the eye; it must be States as of Dec. 31, 1963. Pp. 32. Free, from Editorial Division, Health Insurance Council, 277, Park Avenue, New York, 17. compatible with the medicament dispensed ; and it must 2. Medical Care, Health Status and Family Income. Public Health Service Publication no. 1000, Series 10, no. 9, 1964. Washington, D.C. 3. Evang, K., Murray, D. S., Lear, W. J. Medical Care and Family Security. Englewood Cliffs, New Jersey, 1963. 4. Abel-Smith, B. Paying for Health Services. World Health Organisation, Geneva, 1963.
5. 6. 7.
Anderson, O. W., Colette, P., Feldman, J. J. Changes in Family Medical Care Expenditures and Voluntary Health Insurance. Cambridge, Mass, 1963. Ridley, F. Brit. J. Ophthal. 1958, 42, 641. See Lancet, 1964, ii, 1797.