The Uninsured Crisis

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The Institute of Medicine has released the pre-publication version of America's Uninsured Crisis: Consequences for Health and Health Care. The IOM Committee on Health Insurance Status and Its Consequences found that the country is "caught in a downward spiral: health insurance coverage is declining and will continue to decline."

Some of the committee's key findings include that

• "Health insurance coverage in the US is declining and the situation will get worse. The crisis is engulfing employer-sponsored insurance, the cornerstone of private health coverage, and also threatens expansion in public coverage.
  
• Despite the availability of some safety net services, there is a chasm between health care needs and access to effective health care services for uninsured children and adults. Health insurance coverage in the United States is integral to individuals' personal well-being and health.
• Local health care delivery appears to be vulnerable to the financial pressures associated with high community-level uninsurance rates. Analyses commissioned by the committee and other recent research strongly suggest that when community-level insurance rates are relatively high, insured adults are more likely to have difficulties obtaining needed health care."

This last finding is counter-intuitive and the process by which this occurs is not well understood by the committee. Nevertheless the committee found that "higher community uninsurance is negatively associated with several well-validated indicators of access to and satisfaction with health care for privately insured adults including having a place to go when sick, having a doctor's visit, visiting a doctor for routine preventive care and seeing a specialist when needed..."

The report also refers to the Center for Studying Health System Change which found that "problems in local health care delivery - not necessarily attributable to uninsurance - can be intensified by higher uninsurance rates. For example, providers and capital investment tend to locate ... away from communities with high uninsurance...", among other factors.

The committee concludes that the US must work "on an urgent basis to achieve health insurance coverage for everyone and, in order to make that coverage sustainable, to reduce the costs of health care and the rate of increase in per capita health care spending."

Link here to IOM's report brief on "America's Uninsured Crisis".