Care Without Coverage Too Little, Too Late (2002) / Chapter Skim
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4 The Difference Coverage Could Make to the Health of Uninsured Adults
4 The Difference Coverage Could Make to the Health of Uninsured Adults
Pages 90-104
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From page 90... ...
• Population groups that are most at risk of lacking stable health insurance coverage and that have worse health status, including racial and ethnic minorities and lower-income adults, particularly would benefit from increased health insurance coverage. Increased coverage would likely reduce some of the racial and ethnic disparities in the utilization of appropriate health care services and might also reduce disparities in morbidity and mortality among ethnic groups.
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From page 91... ...
These conclusions take into account the methodological limitations of the largely observational research that supports them, as discussed below. This final chapter considers the broader implications of the Committee's findings, including an assessment of the health-related benefits of insuring American adults who now lack health insurance coverage.
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From page 92... ...
The studies reviewed in Chapter 3 that compare the health outcomes of insured and uninsured populations, even with the extensive analytical adjustments that make these comparisons more valid, do not answer definitively the question of whether health insurance itself improves health outcomes. Nonetheless, the Committee developed its conclusions based on the substantial consistency of results among the methodologically strongest observational studies and the coherence of these results with the behavioral research evidence that informs the Committee's conceptual model of the mechanisms by which health insurance affects health outcomes (see Figure 1.1)
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From page 93... ...
The appropriate use of health care services in screening, early diagnosis, and disease management can reduce the burdens of disability and death due to chronic 3In the National Health Interview Survey, from which these data are reported, limitations of activity refer to long-term reductions in the capacity to perform activities typical for persons in the same age group as the respondent that are due to a chronic health condition. Such activities include personal care (bathing, dressing, eating)
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From page 94... ...
extend to only some of those with chronic conditions. For persons under age 65, 3 million of the 21 million persons under age 65 diagnosed with heart disease, 2 million of the 14 million diagnosed with hypertension, and 1 million of the 8 million diagnosed with arthritis lack health insurance (estimates based on the 1996 Medical Expenditure Panel Survey [MEPS]
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From page 95... ...
. Adults with Severe Mental Illnesses Among chronically ill adults, those with a severe mental illness deserve special attention when considering health insurance coverage because the issues of appropriate care and maintaining coverage are closely related for them.5 Almost 4.5 million Americans, 2.8 percent of adults over age 18, have a severe mental illness (Narrow et al., 2000)
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From page 96... ...
However, even with this relatively high rate of public insurance coverage, 20 percent of adults with a severe mental illness remain uninsured (McAlpine and Mechanic, 2000)
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From page 97... ...
Health insurance more strongly and consistently influences health care utilization than it does health status. While health insurance may alleviate financial barriers to care and improve the choice of providers, it does not address other individual and societal determinants of poor health and disparate care that are experienced by ethnic minorities and the economically disadvantaged.
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From page 98... ...
For example, the RAND Health Insurance Experiment demonstrated that persons with lower incomes and worse health status are most affected by costsharing requirements. Lower-income adults with hypertension who faced no cost sharing had better blood pressure control than those in plans with any amount of cost sharing.
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From page 99... ...
Many of the studies reviewed in the previous chapter, particularly in the management of chronic disease and preventive care, confirmed that more appropriate utilization and better outcomes for insured adults could be accounted for by the greater likelihood of having a regular source of care compared to uninsured adults and those with a recent gap in coverage. Stable health insurance coverage maintains access to a regular source of care over time.
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From page 100... ...
These services, however, are critical elements of appropriate health care that can improve outcomes for conditions such as cancer, cardiovascular disease, diabetes, HIV infection, and depression. Chronically ill adults whose conditions require pharmaceutical therapies are more likely to follow their treatment regimens if they have insurance coverage for prescription drugs (Huttin et al., 2000)
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From page 101... ...
Medicaid is a program with structural features that limit its ability to deliver to enrollees all of the potential benefits of health insurance coverage and it serves adult populations with multiple health risks. INSURING THE UNINSURED: IMPROVING HEALTH OUTCOMES How would health care utilization and health outcomes be affected by providing adults who now lack coverage with health insurance?
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From page 102... ...
Providers would be more likely to provide appropriate services to a patient with a condition of given severity if that patient had health insurance, but could also be more likely to provide services that were not clearly clinically indicated.8 Most importantly, if adults who now lack health insurance were to be insured on a stable and ongoing basis, their health status would likely be better than it would be without health insurance, and their risk of dying prematurely would be reduced. The Committee recognizes that health insurance alone will not eliminate disparities in access to health care among the population now without health insurance nor will it equalize health outcomes among socioeconomically diverse groups.
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From page 103... ...
.9 Thus, although this report has focused almost entirely on health-related outcomes, the most quantifiable and extensively measured personal consequences of health insurance, they account for only some of the benefits of coverage. Financial security and stability, peace of mind, alleviation of pain and suffering, improved physical function, disabilities avoided or delayed, and gains in life expectancy constitute an array of benefits that accrue to members of our society who have health insurance.
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