National Health Policy Conference AcademyHealth

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National Health Policy Conference
AcademyHealth Health Affairs

• Panel on Consequences of Uninsurance January 28,
  2004

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IOM Committee on the Consequences of Uninsurance

• Task
• Assess / consolidate evidence about the health,
  economic and social consequences of uninsurance.
• Raise awareness and improve understanding by both
  the general public and policy makers.
• 6 reports between Fall 2001 and Jan. 2004

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Series Insuring Health

• Coverage Matters (Oct 2001) presented an overview
  of insurance and health care.
• Care Without Coverage (May 2002) documented the
  health impacts for adults of lacking coverage.
• Health Insurance Is a Family Matter (September
  2002) identified health and financial
  consequences of the lack of coverage for families.

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Series Insuring Health (cont.)

• 4. A Shared Destiny (March 2003) traced the
  effects of uninsured populations on communities
  health services and economic and social vitality.
• Hidden Costs, Value Lost (June 2003) explores the
  economic and social effects of uninsurance at the
  national level.
• Insuring Americas Health (January 2004) calls
  for action and sets principles to guide and
  inform the development of policy solutions.

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1. Coverage Matters

• 80 of uninsured live in working families
• Two-thirds live in families earning less than 200
  of FPL
• Most often not a choice health insurance is
  unaffordable for most of uninsured
• More than 70 million lack coverage at some point
  over 3 year period

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Care Without Coverage Too Little, Too Late

• Uninsured adults
• Receive fewer, less timely preventive services
• Less likely to receive appropriate care for
  chronic illness, and have worse outcomes
• Receive poorer hospital-based care
• Cancer patients in poorer health, more likely to
  die prematurely

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Care Without Coverage Too Little, Too Late
(cont.)

• Continuity of coverage matters
• Overall, uninsured have a higher risk of dying
• About 18,000 excess deaths in 2000
• among uninsured age 25-64

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3. Health Insurance is a Family Matter

• One uninsured member impacts entire family
• About 60 million in families with at least one
  member uninsured
• Children in uninsured families receive fewer
  services
• Children in families with an uninsured parent
  less likely to receive appropriate care whether
  or not the child is uninsured.

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4. A Shared Destiny Community Effects of
Uninsurance

• A communitys high uninsured rate can adversely
  affect its health care institutions and
  providers, reducing access to services
• The capacity of clinics and community health
  centers to serve their clientele, including those
  with coverage, is strained by large numbers of
  uninsured patients.

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4. A Shared Destiny Community Effects of
Uninsurance (cont.)

• EMS, trauma care, specialty referrals, services
  for vulnerable populations are less available
• Rural hospitals have lower financial margins,
  fewer ICU beds, less likely to offer high-tech
  services
• The financial instability of health care
  institutions and providers can hurt local
  economies.

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5. Hidden Costs, Value Lost

• Most of costs of uninsurance are not health care
  costs
• Greatest economic losses come from worse health,
  shorter lives
• Estimated annual economic value of foregone
  health for 40 million uninsured is between 65
  billion and 130 billion.

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5. Hidden Costs, Value Lost (cont.)

• Cost of health services for those uninsured for
  any part of a year is about 99 billion (2001)
• Incremental cost of additional services is
  34-69 billion (2001)
• About half of annual increment in spending from
  2000 - 2001

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The value of health capital forgone each year due
to uninsurance is estimated between 65 and 130
billion
18,000 die prematurely.
Uninsured children / adults receive fewer and
less timely services.
8 million uninsured with chronic illnesses
receive fewer services and have increased
morbidity and worse outcomes.
41 million uninsured are less likely to receive
preventive and screening services.
60 million uninsured individuals and their family
members have less financial security and
increased life stress due to lack of insurance.
People in communities with a higher uninsured
rate are at risk for reduced availability of
health care services and overtaxed public health
resources.
All Americans