Care Without Coverage: Too Little, Too Late

Softcover: 212 pages
ISBN 0309083435
978-0309083430
National Academies Press
June 2002
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This is a report from the Committee on the Consequences of Uninsurance, Board on Health Care Services, and Institute of Medicine. This book provides a critical and comprehensive review of research on the effects of health insurance coverage or its lack for adults in the United States.

The second of the committee's six reports examines the health consequences for adults who lack health insurance. It is based on a focused and critical review of clinical and epidemiological research into whether and how having or lacking health insurance affects the care adults receive and their health status as a result.

This six-part series is sponsored by the Robert Wood Johnson Foundation. The six books in this important series include:

2001 - Coverage Matters: Insurance & Health Care
2002 - Care Without Coverage: Too Little, Too Late
2002 - Health Insurance is a Family Matter
2003 - (A) Shared Destiny: Community Effects of Uninsurance
2003 - Hidden Costs, Value Lost: Uninsurance in America
2004 - Insuring America's Health: Principles & Recommendations

"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

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.

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 provided by the publisher)

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