Calm before the storm: expected increase in the number of uninsured Americans

Lack of community insurance and mammography screening rates among insured and uninsured women

PURPOSE

To evaluate whether the proportion of the local population without health insurance coverage is related to whether women undergo mammography screening.

METHODS

Survey data on 12,595 women 40 to 69 years of age from the 2000 to 2001 Community Tracking Study Household Survey were used to analyze the relation between community lack of insurance and whether the respondent had a mammogram within the past year.

RESULTS

Women age 40 to 69 were less likely to report that they had a mammogram within the last year if they resided in communities with a relatively high uninsurance rate, even after adjusting for other factors. After adjusting for individual insurance and other factors, a 10-percentage-point decrease in the proportion of the local insured population is associated with a 17% (95% CI, 13% to 21%) decrease in the odds that a woman age 40 to 69 years will undergo mammography screening within a year.

CONCLUSION

Women living in communities with high uninsurance are substantially less likely to undergo mammography screening. These results are consistent with the view that the negative impact of uninsurance extends to everyone in the community regardless of individual health insurance status.

The U.S. economy and changes in health insurance coverage, 2000-2006

The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. In the first four years of the decade, during a period of economic recession, the number increased by 6.0 million. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults. Employer coverage declined most for self-employed or small-firm workers, in the South, and among noncitizens.

Community-level uninsurance and the unmet medical needs of insured and uninsured adults

OBJECTIVE

To examine the relationship between community-level uninsurance rates and the self-reported unmet medical needs of insured and uninsured adults in the U.S.

DATA SOURCES

2000-2001 Community Tracking Study, which includes data from 60 randomly selected U.S. communities. The sample is representative of the contiguous U.S. states.

STUDY DESIGN

Multilevel logistic regressions were employed to investigate whether the local uninsurance rate was related to having reported unmet medical needs within the last year. The models also included individual and community variables that could be potentially related to both community uninsurance rates and having reported unmet medical needs.

PRINCIPAL FINDINGS

The community uninsurance rate was positively associated with having reported unmet medical needs, but only for insured adults. On average, a five percentage point increment in the local uninsured population is associated with a 10.5 percent increase in the likelihood that an insured adult will report having unmet medical needs during the 12-month period studied.

CONCLUSION

Local health care delivery systems seem to be negatively affected by high uninsurance rates. These effects could have negative consequences for health care access, even for individuals who are themselves insured.

Children welcome, adults need not apply: changes in public program enrollment across states and over time

This article describes changes in the extent of public health insurance coverage for low-income children and adults from 1979 through 2001. Although previous research has demonstrated that public coverage among children has increased substantially during the past 20 years, our work shows that almost all of the increase has occurred among children in families with incomes between 100% and 200% of the federal poverty level (FPL), with little change among children in families with incomes below 100% of FPL. In contrast to the increase in public coverage among children, there has been virtually no change in the generosity of public programs for low-income adults. The overall stability of public coverage for adults masks substantial changes at the state level: public coverage for adults increased substantially in Tennessee, Vermont, Arizona, and other states that implemented Section 1115 Medicaid waivers, while declining in New York, California, and many Rust Belt states.

Access To Conventional Medical Care And The Use Of Complementary And Alternative Medicine

The use of complementary and alternative medicine (CAM) in the United States has greatly increased during the past decade. Using survey data from the 2002 National Health Interview Survey (NHIS), we show that adults who did not get, or delayed, needed medical care because of cost in the prior twelve months were also more likely than all other adults to use CAM. Recent increases in CAM use could be the result of not only the desire for individual empowerment and patient dissatisfaction with conventional medicine, as has been claimed, but also of increases in the relative cost of conventional health care.

U.S. healthcare: the intertwined caduceus of physicians, coverage, quality, and cost

As cardiologists, we should increase our efforts to improve coverage, quality, and cost, both by caring for individual patients and by improving our systems. How? Coverage: by promoting a coordinated approach, beginning with state demonstrations of new safety net and individual and private insurance approaches. Quality: by adopting evidence-based practice and adapting practice guidelines for payment, beginning with non-payment for class III; by setting standards of practice below which we may not fall and paying for quality and service above this level; by involving patients as partners in their care and providing them with incentives. Cost: by challenging routine practices (why return in one year?); by beginning to address the widening gap between what is possible and what is affordable, taking part in broader discussions on what is worth the cost, supporting tort reform, and proposing alternatives; by improving our systems to reduce medical errors and addressing future physician shortages by working in teams with primary care physicians and nurses. Let's work with our patients to improve their health. Together we can make real progress.

Who Walks Through The Door? The Effect Of The Uninsured On Hospital Use

Hospitals are concerned about the implications of an increase in the number of uninsured people. Using data from the 1999 Medical Expenditure Panel Survey (MEPS), we calculate what percentage of hospital inpatient, emergency department, and outpatient visits are accounted for by uninsured people and predict how those shares would change under three different scenarios. We find that although the burden of the uninsured would remain a severe problem for some hospitals, it would not likely increase much for most of them. This finding reflects the relatively low utilization rates among those most likely to lose coverage: nonelderly, nonpregnant, and nondisabled workers and their families.