Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital--based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million -- one in seven--working--age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
"Care Without Coverage: Too Little, Too Late" is the most recent report from the Institute of Medicine on health insurance and access to care, and serves as a follow-up to a previous report Coverage Matters: Insurance and Health Care, which documented the extent of un-insurance and the characteristics of Americans who are most likely to be without insurance. "Care without Coverage" is an exhaustive synthesis of the literature on health insurance coverage and the subsequent effect of health status. The goal of this report is to refute the notion that the 40+ million individuals without health insurance coverage still receive adequate health care that they need, by summarizing the evidence suggesting that the health of individuals is compromised by their lack of insurance coverage. The report summarized a number of studies that examined the role of insurance coverage on health status and concluded that overall, working age adults ages 18-65 years older without health insurance were more likely to suffer from adverse health outcomes or die prematurely than their insured counterparts. Moreover, the report also highlighted studies that demonstrated that the availability of heath insurance could lead to a reduction of gaps in care.
This is an important reference for those interested in documenting the adverse effects of un-insurance on health outcomes. Moreover, the report highlighted a number of factors that may explain why lack of insurance led to poor health outcomes; foremost was the lack of access to timely diagnostic tests or treatments. Even when diagnosed, lack of health care coverage often led to gaps in the receipt of adequate medication or other services, as well as disruptions in care because of a lack of a regular health care provider. In addition, as the treatment for chronic illnesses becomes more paramount, this report is an important contribution, as it highlights the devastating effects of lack of insurance coverage on continuity of care for chronic conditions.
However, there are a number of policy-relevant issues that this report does not fully cover, including the differential effect of insurance coverage on specific racial and ethnic minority groups, and how changes in coverage over time might impact health outcomes, in part because of the lack of supporting studies or data that address these issues. For example, most studies have not examined the impact of changes in insurance coverage over time on health outcomes. That is, are the 40+ million Americans without coverage the same individuals year after year, or do many of them slip into and out of coverage depending on public benefits eligibility, job availability, etc? Also, is there a core group of individuals consistently without coverage, and how can insurance coverage policies be tailored to address the needs of these individuals? Finally, the report focused on insurance coverage for working adults (ages 18-65 years), and did not detail gaps in supplemental health care coverage among adults >=65 years, including access to prescription drug benefits. A more comprehensive assessment of insurance access for this vulnerable population is also warranted, given the recent initiatives to modify Medicare benefits to include prescription drug coverage. Nonetheless, this report is an important resource for those seeking to improve access to health insurance. The obvious next step is to identify the means to increase coverage, especially for vulnerable populations such as racial-ethnic minorities. --Journal of the National Medical Association