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Coverage Matters: Insurance and Health Care PDF

188 Pages·2001·1.3 MB·English
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Coverage Matters Insurance and Health Care Committee on the Consequences of Uninsurance Board on Health Care Services INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by The Robert Wood Johnson Foundation. The views presented in this report are those of the Institute of Medicine Committee on the Consequences of Uninsurance and are not necessarily those of the funding agencies. International Standard Book Number 0-309-07609-9 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2001 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achieve- ments of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineer- ing. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the respon- sibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medi- cine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council. COMMITTEE ON THE CONSEQUENCES OF UNINSURANCE MARY SUE COLEMAN (Co-chair), President, Iowa Health System and University of Iowa, Iowa City ARTHUR L. KELLERMANN (Co-chair), Professor and Chairman, Department of Emergency Medicine, Director, Center for Injury Control, Emory University School of Medicine, Atlanta, Georgia RONALD M. ANDERSEN, Wasserman Professor in Health Services, Chair, Department of Health Services, Professor of Sociology, University of California, Los Angeles, School of Public Health JOHN Z. AYANIAN, Associate Professor of Medicine and Health Care Policy, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts ROBERT J. BLENDON, Professor, Health Policy & Political Analysis, Department of Health Policy and Management, Harvard School of Public Health and Kennedy School of Government, Boston, Massachusetts SHEILA P. DAVIS, Associate Professor, The University of Mississippi Medical Center, School of Nursing, Jackson, Mississippi GEORGE C. EADS, Charles River Associates, Washington, D.C. SANDRA R. HERNÁNDEZ, Chief Executive Officer, San Francisco Foundation, California WILLARD G. MANNING, Professor, Department of Health Studies, The University of Chicago, Illinois JAMES J. MONGAN, President, Massachusetts General Hospital, Boston, Massachusetts CHRISTOPHER QUERAM, Chief Executive Officer, Employer Health Care Alliance Cooperative, Madison, Wisconsin SHOSHANNA SOFAER, Robert P. Luciano Professor of Health Care Policy, School of Public Affairs, Baruch College, New York, New York STEPHEN J. TREJO, Associate Professor of Economics, Department of Economics, University of Texas at Austin REED V. TUCKSON, Senior Vice President, Consumer Health and Medical Care Advancement, UnitedHealth Group, Minnetonka, Minnesota EDWARD H. WAGNER, Director, W.A. McColl Institute for Healthcare Innovation, Group Health Cooperative Puget Sound, Seattle, Washington LAWRENCE WALLACK, Director, School of Community Health, College of Urban and Public Affairs, Portland State University, Oregon v IOM Staff Wilhelmine Miller, Project Co-director Dianne Miller Wolman, Project Co-director Lynne Page Snyder, Program Officer Tracy McKay, Research Assistant Ryan Palugod, Project Assistant vi Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures ap- proved by the NRC’s Report Review Committee. The purpose of this indepen- dent review is to provide candid and critical comments that will assist the institu- tion in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the follow- ing individuals for their review of this report: BRUCE BRADLEY, Director, Managed Care Plans, General Motors Health Care Initiatives, Detroit, Michigan HARRY P. CAIN, Adjunct Faculty Member, Graduate School of Business, College of William and Mary, Williamsburg, Virginia JACOB FELDMAN, Senior Fellow, Center for Health Affairs, Project HOPE, Bethesda, Maryland ROBERT L. JOHNSON, Professor of Pediatrics & Clinical Psychiatry, Direc- tor, Adolescent & Young Adult Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark SCOTT C. RATZAN, Senior Technical Advisor and Population Leadership Fellow, Center for Population, Health, and Nutrition, U.S. Agency for Interna- tional Development, Washington, D.C. DIANE ROWLAND, Executive Vice President, Henry J. Kaiser Family Foun- dation, Executive Director, The Kaiser Commission on Medicaid and the Unin- sured, Washington, D.C. vii viii REVIEWERS FRANK A. SLOAN, J. Alexander McMahon Professor of Health Policy and Management, Professor of Economics, Director, Center for Health Policy, Law & Management, Duke University, Durham, North Carolina KATHERINE SWARTZ, Professor of Health Economics, Department of Health Policy and Management, Harvard School of Public Health, Boston, Mas- sachusetts DAVID TAKEUCHI, Professor of Sociology, Indiana University, Bloomington Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommenda- tions nor did they see the final draft of the report before its release. The review of this report was overseen by Hugh H. Tilson, Adjunct Professor, School of Public Health, University of North Carolina, Chapel Hill, appointed by the Institute of Medicine and Joseph P. Newhouse, John D. MacArthur Profes- sor of Health Policy & Management, Harvard University, appointed by the NRC’s Report Review Committee, who were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Preface This is the first report in a series of six that the Institute of Medicine (IOM) Committee on the Consequences of Uninsurance will issue over the next two years to evaluate and consolidate our knowledge of the causes and consequences of lacking health insurance. The Committee was established just one year ago with the charge of reviewing and assessing evidence across a spectrum of disciplines to expand our understanding of the problem of uninsurance. The Committee agreed to undertake this formidable task in order to delineate more clearly the personal, family, community, and economic consequences of the existing public and private health insurance mechanisms—a system that leaves almost one out of six Ameri- cans without coverage. This initial report of the Committee establishes both a conceptual framework and baseline data about the magnitude and extent of the problem nationwide. It seeks to answer the basic questions of who, when, where, and why so many Americans lack health insurance. The report provides an overview of health insurance in America, describes the dynamic and often unstable nature of insur- ance coverage, profiles populations that frequently lack coverage, and identifies factors that make it more or less likely that a person will be uninsured at some point in life. Finally, the report outlines the research agenda that the Committee will pursue in this series of six reports. Many people have made substantial contributions to this report. The Sub- committee on the Status of the Uninsured, chaired by Willard Manning, produced a draft for the full Committee’s consideration within an extraordinarily short time and continued to work with the full Committee in revising the initial draft. Committee members John Ayanian, Sheila Davis, Willard Manning, and Larry Wallack were joined on the subcommittee by Peter Cunningham, Paul Fronstin, ix

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