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At least 19 recordsLinked to original sources
PubMed1989

A profile of the medically uninsured in Georgia.

The provision of health care to the growing number of persons uninsured against medical expenses affects Georgia doctors, hospitals, and state and local government at all levels. While much is known nationally about the uninsured, there are no good data about this group in Georgia. This study uses U.S. Census Bureau data to provide a demographic profile of Georgians who lack health insurance and to identify groups at particular risk for being uninsured. Approximately 950,000 (17.7%) of non-elderly Georgia residents are uninsured, compared to 37 million (17.6%) in the U.S. as a whole. As is true generally in the U.S., those in Georgia who are poor, young, non-white, and in families with a female head are at greatest risk. Of particular note are the poor in Georgia with incomes from 50% to 100% of the federal poverty level (55.2% uninsured). This population deserves the special attention of all involved in finding a solution to this problem.

Employment↗
PubMedDate not supplied

Who are the medically uninsured in the United States?

The Employee Benefit Research Institute (EBRI) analysis of the March 1993 Current Population Survey revealed that 38.9 million Americans had no private or public health insurance during 1992. This number was up some 2.3 million over that for 1991, an increase larger than was experienced from 1989 through 1991. The proportion of the total population without such insurance also steadily increased, rising from 14.3 percent in 1989 to 15.4 percent in 1992. In 1992, 38.5 million nonelderly Americans, or 17.4 percent of those under age 65, had no health insurance, up 4.1 million since 1989. A primary reason for the rising number of the nonelderly uninsureds was a decline in health coverage among individuals (and their families) working for small firms. Among the total U.S. population, close to 59 percent received employment-based coverage. Of the remainder, Medicare accounted for just over 13 percent of the coverage, Medicaid for just over 11 percent and individually purchased private sources other than an employer or union for almost 12 percent. The New England region had the lowest proportion of medically uninsureds (almost 12 percent) and the West South Central the highest (over 25 percent). By state, Hawaii and Connecticut reported the lowest percentage of medically uninsureds, whereas Nevada, Oklahoma, Louisiana and Texas reported the highest proportions in 1992.

Adolescent↗
PubMed1990

The medically uninsured: problems, policies, and politics.

The ranks of the medically uninsured have grown significantly in recent years, but no consensus on a policy solution has emerged. After summarizing the characteristics of the uninsured population, this paper reviews diverse policy responses and their troubled political prospects.

Federal Government↗
PubMed1990

Medically uninsured children in the United States: a challenge to public policy.

This article is an examination of the nature and extent of the problem presented by medically uninsured children in the United States. First, the characteristics of the uninsured population are explored with a description of how age, family income, and employment status disproportionately affect families with children. Second, the Medicaid program and its historically inadequate response to this growing problem of uninsured children is examined. Third, the relationship between insurance status and the health and development of children is discussed. Finally, recent public policy initiatives that have been enacted or proposed to address this inequity in the present health care system are reviewed with a recommendation to establish a "Universal Maternal and Child Health Program."

Adolescent↗
PubMed1990

Medically uninsured children in the United States: a challenge to public policy.

This article is an examination of the nature and extent of the problem presented by medically uninsured children in the United States. First, the characteristics of the uninsured population are explored with a description of how age, family income, and employment status disproportionately affect families with children. Second, the Medicaid program and its historically inadequate response to this growing problem of uninsured children is examined. Third, the relationship between insurance status and the health and development of children is discussed. Finally, recent public policy initiatives that have been enacted or proposed to address this inequity in the present health care system are reviewed with a recommendation to establish a "Universal Maternal and Child Health Program."

Adolescent↗
PubMed1991

Politics and equity in policy-making for the medically uninsured.

A sizable number of Americans (many of low income) lack health insurance, and their ranks grew over the 1980s. One might expect to find vigorous political efforts to redress this inequity. In fact, conflicting normative and practical images of equity have blunted the sense of urgency of the problem, inhibited agreement on the proper division of labor between the market and government, and blocked consensus on strategic models for public policy for the uninsured.

Health Policy↗
PubMed1987

National policy and the medically uninsured.

Although the marketplace discipline imposed on the health care sector appears to be restraining increases in the cost of care, this haphazard and incremental "policy" is having deleterious effects on access to care by the uninsured. To help alleviate this problem within our current price-centered system, I suggest that three options be pursued: create state pools to fund indigent care; broaden insurance coverage availability through the workplace; and create medical individual retirement accounts to pay for long-term care, which would free up more funds for indigent care. We must mold our future health care system during this era of rapid change by developing a coherent policy, with input from both the private and the government sectors, to create an efficient and high-quality system that will provide needed care to all members of society.

Adolescent↗
PubMed1992

Private insurance reform in the 1990s: can it solve the health care crisis?

A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.

Adult↗
PubMed1993

A study of Minnesota's high-risk health insurance pool.

This is a report of a study of Minnesota's high-risk health insurance pool for "medically uninsurable" persons. The study consisted of a survey of current and past enrollees carried out in the Spring of 1990 and an analysis of the claims and membership files for 1988 and 1989. The main policy conclusion we reached is that Minnesota's high-risk pool is an adequate approach to the problem raised by risk segmentation on the basis of health status, providing that enrollment remains a small fraction of the population. The recent high, enrollment growth rates the Minnesota risk pool has experienced raise the possibility that basic structural reforms of the nongroup and small-group health insurance markets are needed.

Adolescent↗
PubMed1995

Medical savings accounts and the uninsured in Oklahoma.

Medical savings accounts (MSAs) and medical IRAs are important components of a "market-based" strategy for health care reform that have been opposed by many physicians for several reasons including lack of the applicability of these concepts to solving the problem of the uninsured. On closer inspection of the uninsured in Oklahoma, it is apparent that the majority of the uninsured in Oklahoma are in groups with annual incomes which allow a majority of persons within those groups to afford health insurance. Medical savings accounts are flexible, affordable, and portable forms of health coverage which are already being used in other states by significant numbers of persons with annual incomes similar to the majority of Oklahomans who are uninsured. Physicians are encouraged to support the implementation of these concepts as well as other market-based concepts in order to bring about fiscally responsible and truly effective health care reform.

Aged↗
PubMed1989

Cost effectiveness of current approaches to the control of retinopathy in type I diabetics.

Diabetic retinopathy is a leading cause of blindness among working age Americans. The epidemiology of diabetic eye disease has been well described in population-based studies and the effects of laser treatment have been tested in randomized controlled trials. The authors have designed a computer simulation model using the published reports of these studies to predict the medical and economic effects of applying currently accepted methods for the control of diabetic retinopathy to the population of type I diabetics. Recommendations for screening are taken from the Public Health Committee of the American Academy of Ophthalmology. Treatment recommendations and treatment efficacy are drawn from the reports of the Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS). Costs of screening and treatment are drawn from published Medicare reimbursement data. Over a 60-year period, the model predicts that proliferative diabetic retinopathy (PDR) requiring panretinal photocoagulation (PRP) will eventually develop in 72% of type I diabetics and macular edema will develop in 42%. If these treatments are delivered as recommended in the clinical trials, the model predicts a cost of $966 per person-year of vision saved from proliferative retinopathy and $1118 per person-year of central acuity saved from macular edema. This is only one seventh of the $6900 average cost of 1 year of Social Security Disability for those disabled by vision loss. Therefore, this model supports the use of federally funded eye care to prevent blindness in medically uninsured diabetics.

Adolescent↗
PubMedDate not supplied

An inner-city cancer prevention clinic in West Oakland, California.

This article reports on a 3-year (1989-1992) American Cancer Society demonstration project in which a multidisciplinary, continuity-of-care-based comprehensive cancer prevention, education, and early detection clinic was established within an already existing inner-city health center in West Oakland, California. A total of 2058 patients (79% African-American, 78% female, 50% medically uninsured) received 7349 services (3.6 services per patient; averaging 2.5 hours over multiple visits, with 75%-85% appointment-keeping compliance), ranging from risk assessment and education to physical examinations, smoking counseling, mammography, and flexible sigmoidoscopy. In addition to 22 precancers and 15 cancers being diagnosed, statistically significant gains were demonstrated in patient knowledge, attitudes, and behavior. There was high patient satisfaction, particularly with nurse practitioners as service providers. Cancer prevention education was provided to an additional 14,945 community members, targeting students, teen parents, and recovering substance abusers. An in-depth qualitative analysis of recovering substance abusers examined their cancer beliefs and attitudes and showed significant knowledge gains from a subsequent cancer education program. The overall project demonstrated the feasibility of providing comprehensive and effective cancer prevention, education, and early detection services to the poor.

Adolescent↗
PubMed1995

Health care utilization and attitudes toward health insurance. A comparison of privately insured and medical assistance or uninsured patients.

A questionnaire was distributed to 108 patients to find if there were differences in health care resource usage and attitudes towards health insurance between patients seen in the hand clinic, designed for patients with medical assistance or without insurance (57 patients), and those seen in the private offices of staff hand surgeons (51 patients). Clinic patients reported a mean of 18 visits to their physician in the past year as compared with 7 for private patients (P < 0.0005) and attended 52% of their scheduled appointments as compared to an 83% attendance rate for private patients (P < 0.001). Patients enrolled in a medical assistance program were less willing to pay for their health care than were private patients. Sixty-two percent of clinic patients responded that they would not be willing to pay anything at all for their health care coverage. These data suggest that health care and health insurance is a lower priority for the clinic patient. Any new health care system that includes the uninsured and underinsured must be prepared to handle different attitudes toward health care and an increase in utilization of resources.

Adult↗