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Uninsured people in USA put a strain on health system
Uninsured people in USA put a strain on health system
MEDICINE AND HEALTH POLICY
he number of people in the USA without health insurance and the consequent strain on the entire US health system is the public policy issue that “is really the elephant in the living room in US health care; everything else pales by comparison”, Arthur Kellermann (Emory University, Atlanta, GA), co-chair of the Institute of Medicine’s Committee on the Consequences of Uninsurance, told The Lancet. The committee’s report, A shared destiny: effects of uninsurance on individuals, families, and communities”, was released on March 6 (http://www.iom.edu). 41 million people in the USA do not have health insurance—some 14·6% of the total population. However, a new study by Families USA showed that a much higher number—nearly a third of the non-elderly population, or about 75 million people—lacked health insurance for some part of 2001–02. Of these, two-thirds were without insurance for 6 months or longer, and 71% were employed, either full-time or part-time, according to the report, entitled Going without health insurance, (see panel and http://coverthe uninsuredweek.org/media/GoingWitho utReport.pdf). Hispanics and AfricanAmericans were more likely to be uninsured than non-Hispanic whites. The publication of the two reports coincides with a major public initiative called “Cover the Uninsured Week”, from March 10–16. During this week, several groups dubbed by the media as “strange bedfellows”—including the Robert Wood Johnson Foundation, the American Medical Association, the US Chamber of Commerce, Blue Cross and Blue Shield, labour unions, and others—will come together to raise awareness of the issue in a wide variety of forums, from health fairs and town hall meetings to prayer breakfasts and storylines on popular television shows. Uninsurance is an important issue for a number of reasons: uninsured people often lack a regular source of medical care, and are therefore forced to use emergency departments for this; they are less likely to get screening and preventive care, or care for chronic conditions; they receive diagnoses later, are sicker, and are more likely to die earlier than insured persons; they have higher rates of admissions for avoidable conditions; and medical care eventually costs the uninsured more than the insured.
T
Science Photo Library
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
938
Main findings from the Going without health insurance report In three of the four largest US states (California, Florida, and Texas), more than one out of three non-elderly Americans were uninsured in 2001–02.
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10% of the 74·7 million uninsured were without coverage for 2 months or less.
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52·5% were estimated to be uninsured for at least 9 months during 2001–02.
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Approximately 80% of the uninsured were in working families.
●
52% of the uninsured were nonHispanic whites. However, racial minorities were more likely to be uninsured than whites.
●
The non-elderly age group with the highest likelihood of experiencing an uninsured spell during 2001–02 was 18–24 year olds (49·6%), followed by 25–44 year olds (32·7%).
●
Source: www.covertheuninsuredweek.org
But the consequences of uninsurance extend beyond individuals. On a local level, high percentages of uninsured people create enormous problems in the whole fabric of health care for communities, with time-critical services, such as emergency medicine, trauma care, and hospital-based speciality care, most directly affected. Kellermann noted that in a time when “homeland security” is supposed to be uppermost in the minds of people in the USA, it is ironic that two important first lines of defence—emergency medical services and trauma centres—are unravelling under the pressure of high rates of uninsurance and other economic burdens. He recalled Tip O’Neill, the late speaker of the US House of Representatives, who famously said, “all politics is local”. Kellermann said, “All health care is local, too. The effects are shared across communities and are not borne only by the uninsured. Health care in America is a like a jumbo jet. It’s huge, expensive, and complicated. Now there are cracks in the wings, and we’re all sitting on the plane”. Faith McLellan
THE LANCET • Vol 361 • March 15, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
MEDICINE AND HEALTH POLICY
he number of people in the USA without health insurance and the consequent strain on the entire US health system is the public policy issue that “is really the elephant in the living room in US health care; everything else pales by comparison”, Arthur Kellermann (Emory University, Atlanta, GA), co-chair of the Institute of Medicine’s Committee on the Consequences of Uninsurance, told The Lancet. The committee’s report, A shared destiny: effects of uninsurance on individuals, families, and communities”, was released on March 6 (http://www.iom.edu). 41 million people in the USA do not have health insurance—some 14·6% of the total population. However, a new study by Families USA showed that a much higher number—nearly a third of the non-elderly population, or about 75 million people—lacked health insurance for some part of 2001–02. Of these, two-thirds were without insurance for 6 months or longer, and 71% were employed, either full-time or part-time, according to the report, entitled Going without health insurance, (see panel and http://coverthe uninsuredweek.org/media/GoingWitho utReport.pdf). Hispanics and AfricanAmericans were more likely to be uninsured than non-Hispanic whites. The publication of the two reports coincides with a major public initiative called “Cover the Uninsured Week”, from March 10–16. During this week, several groups dubbed by the media as “strange bedfellows”—including the Robert Wood Johnson Foundation, the American Medical Association, the US Chamber of Commerce, Blue Cross and Blue Shield, labour unions, and others—will come together to raise awareness of the issue in a wide variety of forums, from health fairs and town hall meetings to prayer breakfasts and storylines on popular television shows. Uninsurance is an important issue for a number of reasons: uninsured people often lack a regular source of medical care, and are therefore forced to use emergency departments for this; they are less likely to get screening and preventive care, or care for chronic conditions; they receive diagnoses later, are sicker, and are more likely to die earlier than insured persons; they have higher rates of admissions for avoidable conditions; and medical care eventually costs the uninsured more than the insured.
T
Science Photo Library
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
938
Main findings from the Going without health insurance report In three of the four largest US states (California, Florida, and Texas), more than one out of three non-elderly Americans were uninsured in 2001–02.
●
10% of the 74·7 million uninsured were without coverage for 2 months or less.
●
52·5% were estimated to be uninsured for at least 9 months during 2001–02.
●
Approximately 80% of the uninsured were in working families.
●
52% of the uninsured were nonHispanic whites. However, racial minorities were more likely to be uninsured than whites.
●
The non-elderly age group with the highest likelihood of experiencing an uninsured spell during 2001–02 was 18–24 year olds (49·6%), followed by 25–44 year olds (32·7%).
●
Source: www.covertheuninsuredweek.org
But the consequences of uninsurance extend beyond individuals. On a local level, high percentages of uninsured people create enormous problems in the whole fabric of health care for communities, with time-critical services, such as emergency medicine, trauma care, and hospital-based speciality care, most directly affected. Kellermann noted that in a time when “homeland security” is supposed to be uppermost in the minds of people in the USA, it is ironic that two important first lines of defence—emergency medical services and trauma centres—are unravelling under the pressure of high rates of uninsurance and other economic burdens. He recalled Tip O’Neill, the late speaker of the US House of Representatives, who famously said, “all politics is local”. Kellermann said, “All health care is local, too. The effects are shared across communities and are not borne only by the uninsured. Health care in America is a like a jumbo jet. It’s huge, expensive, and complicated. Now there are cracks in the wings, and we’re all sitting on the plane”. Faith McLellan
THE LANCET • Vol 361 • March 15, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.