ACCESS / MEASURES (A/M)
The Kaiser Commission on
Medicaid
and the Uninsured (for
further information)
provides a periodically updated statistical
review
of the uninsured based upon U.S Census Bureau survey data.
The
most common measure of access is the proportion of the nonelderly
population (or
the number of persons) uninsured (in 2004, for the U.S.: 11.6% of
children
and 20.6% of nonelderly adults, a total of 45.5 million persons).
A related, but less certain measure, is the proportion or number
of "underinsured."
Such data are detailed, in order to better measure the problem and to
design effective corrections, by looking at the age, employment and
occupational status, geographic distribution, income, race, etc.
One characteristic of the uninsured that deserves careful attention is
the health status of this population. This provides an indication of
whether the pressure to limit expenditures for health care is resulting
in increased discrimination in insurance, employment, etc. against
those
with poor health or poor health prospects. From year to year, the
total number of uninsured may hold constant, but if this number
includes
an increasing proportion of persons with serious health problems, the
problem
of the uninsured is growing.
See for example, in the most recent review,
pages 6, 7, 11, 18, and 19.
Kaiser's
Commission
also provides information by (for
further information) state.
Insurance alone is an inadequate measure of access. Other aspects
that deserve attention include:
- Coverage, i.e. the benefit plan provided by the insurance.
Medicare, when it was passed in 1965, did not include outpatient
pharmaceutical charges in its benefits plan. As pharmaceuticals became
more important
in good health care and as these charges increased, Medicare provided
less adequate access to health care. This is a primary concern of
recent or recently discussed (for further information)
Medicare reform efforts.
- Satisfaction
(for further information) with
available care in terms of quality, cultural sensitivity, etc.
- Outcome of available care. [detailed data:
e.g. ambulatory care sensitive hospital discharges].
The purposes and (for further
information) structure
of
the insurance market
does much to shape access. Insurers face
extraordinary incentives to avoid those with health problems or to
offer premiums that are beyond their means.
Families USA, in a study
for the Robert Wood Johnson Foundation issued in March, 2003
reported that 75,000 persons were uninsured at some time during the
past two years.
The Institute of Medicine issued (for further information)
a study
in March, 2003 analyzing the impact of the uninsured upon the larger
community.