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You are here > Home > Reading Lists > Politics, Policy & Reform > A Shared Destiny A Shared Destiny: Community Effects
of Uninsurance Softcover: 296 pages
This report explores the complex interrelationships between populations of insured and uninsured and the effects on total health care in the community. "It is misguided and even dangerous to assume that lack of health insurance harms only those who are uninsured," said Arthur Kellermann, co-chair of the committee that wrote the report, and professor and chair of emergency medicine at Emory University School of Medicine, Atlanta. "The rest of the community pays for uncompensated medical care either directly or indirectly, and high rates of uninsurance can strain community health systems to the point that important services have to be cut or eliminated." A Shared Destiny is the fourth in a series of six reports on the problems of uninsurance in the United States. This report examines how the quality, quantity, and scope of community health services can be adversely affected by having a large or growing uninsured population. It explores the overlapping financial and organizational basis of health services delivery to uninsured and insured populations, the effects of community uninsurance on access to health care locally, and the potential spillover effects on a community s economy and the health of its citizens. The committee believes it is both mistaken and dangerous to assume that the persistence of a sizable uninsured population in the United States harms only those who are uninsured. "...an exhaustive review of the research literature and original analysis of hospital data... A review of the available evidence makes a convincing case that high levels of uninsurance can create financial strains sufficient to affect the more general supply and capacity of the health care system. ... Although more research is needed, A Shared Destiny is an excellent start and resource for broadening this discussion." -- Journal of the American Medical Association This six-part series is sponsored by the Robert Wood Johnson Foundation. The six books in this important series include:
Communities with high rates of
uninsurance are more likely to reduce hospital services, divert
public resources away from disease prevention and surveillance
programs, and reallocate tax dollars so that they can pay for
uncompensated medical care, says a new report from the Institute of
Medicine of the National Academies. The presence of large numbers of
uninsured people can result in reduced access to emergency care,
specialty services, and hospital care across the community -- even
for those who have health coverage. There is little evidence that the public funds that pay for the bulk of uncompensated medical care for uninsured patients are being allocated or targeted efficiently, however. If sufficient public funds are not available, resources may have to be diverted from other public purposes to pay for health programs, the committee found. For example, Hillsborough County in Florida had to reallocate $2.5 million in property taxes that had been earmarked for road construction to help offset a $6.6 million shortfall in a program serving the medical needs of the uninsured and indigent. Lack of reimbursement for care provided to the uninsured has contributed to the unavailability of specialty care in some areas and prompted some facilities not to offer the kinds of services that the uninsured tend to use, such as HIV/AIDS and trauma care. For example, some specialists in Phoenix have ended affiliations with certain hospitals, or refused to offer on-call services, in part to avoid treating uninsured patients for whom they do not expect to be reimbursed. The shortage of specialists willing to provide treatment at these facilities also affects insured patients. When patients lack access to care, their health problems may have an even more direct impact on others. For instance, almost 20 percent of people infected with HIV are uninsured; these individuals are less likely to be aware of their infection status because they lack regular care, and hence they may be at greater risk of transmitting the virus to others. A number of cities across the United States have closed facilities or converted them from public entities to for-profit ones due in part to the burden of uncompensated care, the report notes. Insured as well as uninsured people may feel the impact of the reduced availability of services. For example, Los Angeles County closed 11 of its 18 public health clinics and one of six public hospitals last year. The county also cut roughly 5,000 jobs. Officials in Milwaukee, Boston, and Hillsborough County, Fla., cited the burden of unreimbursed costs as a factor in their decisions to switch three large urban hospitals to private ownership. Shifting costs to private insurance payers is not likely to lighten the burden placed on communities by uncompensated care. Efforts to control health costs over the past 25 years have constrained insurance payments to hospitals. Consequently, hospital surpluses generated from privately insured patients have dwindled from a high of nearly 12 percent in 1992 to just 5 percent in 2000. Meanwhile, the proportion of costs from uncompensated care has remained relatively constant on average nationally, increasing the financial burden on hospitals. Hospitals generally have attempted to control costs by reducing the number of staffed inpatient beds. However, fewer staffed beds can translate into longer wait times before patients who require admission are transferred out of the emergency room. The resulting overcrowded emergency rooms reduce access to emergency and trauma care for everyone in the community. High rates of uninsurance also take a toll on local public health departments, an important part of the health care safety net. Public health officials across the country report feeling caught between diminishing budgets, demands for populationwide services, and an increasing need to provide medical care to the uninsured. The result may be a shift of funds toward health care delivery at the expense of disease surveillance, injury control, and other traditional public health programs, the report says. This is a serious concern, given that public health departments play a crucial role in detecting and responding to bioterrorist attacks and naturally occurring disease outbreaks. Nationwide, 16.5 percent of the population under age 65 lacks health coverage, according to the March 2002 Current Population Survey by the Census Bureau. Uninsurance rates vary by state, from a low of 8.7 percent in Iowa to a high of 26 percent in Texas. In California, New Mexico, Arizona, Oklahoma, Louisiana, and Florida, one in five residents lacks coverage. Fourteen other states have uninsurance rates exceeding 15 percent. With the publication of this report, the fourth in a series on the consequences of uninsurance, the IOM offers the most complete evidence-based picture of the problem and all its effects on the individual, the family, and whole communities. "By exploring in depth the health, social, and financial consequences of lack of coverage, this report and its companions correct several misperceptions that surround the uninsured, such as the notion that the problem affects only the indigent and those who lack health coverage," said Mary Sue Coleman, committee co-chair and president of the University of Michigan, Ann Arbor. The Institute for Healthcare Improvement (IHI) is a not-for-profit organization driving the improvement of health by advancing the quality and value of health care. IHI is a reliable source of energy, knowledge, and support for a never-ending campaign to improve health care worldwide. We develop and nurture will, energizing a movement for profound change in health care. We spread improvement knowledge across the globe, and provide methods, tools, and other supports, largely through partnerships, for thousands of health care organizations to turn knowledge into improved results. We initiate and support innovation efforts, so as to discover, cultivate, and demonstrate the feasibility of new, more capable, designs. We exercise academic rigor in this work. We work to change the skills, attitudes, and knowledge of the workforce, both in the ongoing development of young professionals and in life-long education, so as to reduce profession-specific silos that limit collaborative effort for the well-being of patients. We seek to improve joy in work, and to help all who work in health care to become better able to help improve care. The Institute of Medicine (IOM) serves as adviser to the nation to improve health. As an independent, scientific adviser, the Institute of Medicine strives to provide advice that is unbiased, based on evidence, and grounded in science. The mission of the Institute of Medicine embraces the health of people everywhere. Softcover: 296 pages
This report explores the complex interrelationships between populations of insured and uninsured and the effects on total health care in the community. The National Academies Press (NAP) was created by the National Academies to publish the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council, all operating under a charter granted by the Congress of the United States. The NAP publishes more than 200 books a year on a wide range of topics in science, engineering, and health, capturing the most authoritative views on important issues in science and health policy. The institutions represented by the NAP are unique in that they attract the nation's leading experts in every field to serve on their award-winning panels and committees. If you are interested in policy or books about health care reform, please see our up-to-date collection here: Politics, Policy & Reform. (information from the publisher) Jump to a List / Health Administration & Leadership / Physician Executive, Medical Staff & Practice Management / Finance, Accounting, Economics, Billing & Reimbursement / Coding for Hospital, Physician & Clinical Services / Law, Malpractice, Ethics, Accreditation & Compliance / Quality Improvement, Outcomes & Customer Service / Risk Management, Security, Error Reduction & Patient Safety / Information Systems, Technology & Medical Records / Clinical Management & Executive Nursing / Behavioral Health, Social Work & Psychiatry Management / Human Resources, Management & Supervision / Directories, Data, Trends & Benchmarks / Software & CD-ROMs / Gift Ideas & Recommended Gifts / Journals, Magazines & Newsletters / Search for Books / Books Index / You may also be interested in: / Directory of Healthcare Recruiters / Return to Pages: / Home Page / Toolbox for Health Administrators / Book Lists & Bookstore |
