- Email: [email protected]
Left out in the cold
reach a 2:l HIV-ALDS calculation. (It must be noted that this ratio means that many HIV-positive individuals are obviously still undekcted and/or not under treatment) Cost estimates are again based on available published information but also include data from a Pittsburgh area study of 169 seropositive individuals. Hellinger concludes that the total average costa for this population are $5,150; total care cast8 for this population are estimated to be $1.4 billion in 1991 and $25 billion in 1994. These estimates provide guideposts for policymakem seeking information to assist in projecting costs associated with the HIV epidemic. However, such calculations must be accompanied with important caveats. The mercurial nature of this epidemic, with changes in the disease and in the health care sectors’ responses to it, suggests that cautious application of estimates to particular scenarios is warranted. In addition, Hellinger’s estimates of the co&s for HIV care are substantially dependent on a study of a small number of seropositives from an area not as hard hit or diverse with respect to mode of transmission or demographics as many of the major HIV centers whose populations may require substantially more inpatient care. Taken in this context, such estimates should be carefully adjusted when applied to specific communities.-DPA
Left Out in the Cold [Himmelstein DU, Woalhandler Who cares for the care givers? JAMA 1991; 266: 3994OI.]
0
S.
f the 37 million persons without health insurance, about two-thirds work fullor part-time. Most of these people work in a variety of small II
busine.sses from across all segments of the economy, including the health care industry. Himmelstein and Woolhandler analyzed data from the March 1990 Current Population Survey to describe the contribution of health care workers to the ranks of the medically uninsured. Approximately 9% of health care workers are without health insurance compared with more than 14% of employees in other industries. The lowest paid health workers-aides, food service staff, and laundry and housekeeping staff-are disproportionately uninsured, more than 18% on average. Only 2.3% and 2.9% of physicians and registered nurses, respectively, are uninsured. The insurance status of health personnel also varies by site of employment. More than 7% of employees in office-based settings are uninsured compared with 5.9% of hospital employees. However, it is the nursing home employee who is most often left without health insurance. More than 20% of these workers are uninsured, and only 52.6% of those who are insured receive any employer contribution toward their premium. Again, the lowest paid workers are the least likely to have health insurance. For example, as many as 30% of food service personnel are uninsured. The medically uninsured have many faces. It is particularly ironic and telling that so many care givers are themselves left out in the cold. Undoubtedly, the reasons for lack of health insurance among health workers are multiple and complex and add more fuel to the debate for providing universal access to health care. As policymakers consider proposals that focus on mandated employer contributions for expanding coverage to the working uninsured, they should bear
May 1992 The American Journal of Medicine
Volume 92
in mind the authors’ point that the cost of increasing coverage to health care workers under such proposals would have to either come out of the profits of health care providers, vr get passed on to the consumer as higher health care bills. Given the behavior of the health care market thus far, who do you think would end up paying?-MM
G-O-M-E-R! [Hagland MM. Violant incidents lend new apprehension to ED work. Hospitals 1992; 20: 30-2. McNamara P. Neu AHA surwy: emergency departments in gridlock. Hospitab 1992; 20: 3830. Friedman E. The sagging safet:, net: emergency department on the brink vf crisb. Hospitals 1992; 20: 26-30.1
T
hree consecutive reports in the latest issue of Hospitals announce the arrival of a national crisis in emergency department (ED) care. Total ED visits are up sharply; ambulance diversions are increasingly common; ED patients wait for longer and longer periods to receive care; and violent incidents occurring in EDs, while not yet common, have become shockingly frequent. Fear for one’s personal safety has increased anxiety among ED clinicians, and there is a concern that the unsafe, overcrowded, gridlocked conditions will make it difficult or impossible to recruit the next generation of emergency room health care professionals. While no area of the country has been spared from these developments, the problems are most intense in the central-city “safety net” hospitals that have always provided the “care of last resort” to the urban poor.
Left Out in the Cold [Himmelstein DU, Woalhandler Who cares for the care givers? JAMA 1991; 266: 3994OI.]
0
S.
f the 37 million persons without health insurance, about two-thirds work fullor part-time. Most of these people work in a variety of small II
busine.sses from across all segments of the economy, including the health care industry. Himmelstein and Woolhandler analyzed data from the March 1990 Current Population Survey to describe the contribution of health care workers to the ranks of the medically uninsured. Approximately 9% of health care workers are without health insurance compared with more than 14% of employees in other industries. The lowest paid health workers-aides, food service staff, and laundry and housekeeping staff-are disproportionately uninsured, more than 18% on average. Only 2.3% and 2.9% of physicians and registered nurses, respectively, are uninsured. The insurance status of health personnel also varies by site of employment. More than 7% of employees in office-based settings are uninsured compared with 5.9% of hospital employees. However, it is the nursing home employee who is most often left without health insurance. More than 20% of these workers are uninsured, and only 52.6% of those who are insured receive any employer contribution toward their premium. Again, the lowest paid workers are the least likely to have health insurance. For example, as many as 30% of food service personnel are uninsured. The medically uninsured have many faces. It is particularly ironic and telling that so many care givers are themselves left out in the cold. Undoubtedly, the reasons for lack of health insurance among health workers are multiple and complex and add more fuel to the debate for providing universal access to health care. As policymakers consider proposals that focus on mandated employer contributions for expanding coverage to the working uninsured, they should bear
May 1992 The American Journal of Medicine
Volume 92
in mind the authors’ point that the cost of increasing coverage to health care workers under such proposals would have to either come out of the profits of health care providers, vr get passed on to the consumer as higher health care bills. Given the behavior of the health care market thus far, who do you think would end up paying?-MM
G-O-M-E-R! [Hagland MM. Violant incidents lend new apprehension to ED work. Hospitals 1992; 20: 30-2. McNamara P. Neu AHA surwy: emergency departments in gridlock. Hospitab 1992; 20: 3830. Friedman E. The sagging safet:, net: emergency department on the brink vf crisb. Hospitals 1992; 20: 26-30.1
T
hree consecutive reports in the latest issue of Hospitals announce the arrival of a national crisis in emergency department (ED) care. Total ED visits are up sharply; ambulance diversions are increasingly common; ED patients wait for longer and longer periods to receive care; and violent incidents occurring in EDs, while not yet common, have become shockingly frequent. Fear for one’s personal safety has increased anxiety among ED clinicians, and there is a concern that the unsafe, overcrowded, gridlocked conditions will make it difficult or impossible to recruit the next generation of emergency room health care professionals. While no area of the country has been spared from these developments, the problems are most intense in the central-city “safety net” hospitals that have always provided the “care of last resort” to the urban poor.