Health Insurance is a Family Matter (Insuring health)

297 Pages·2002·4.93 MB·English

by  Committee on the Consequences of Uninsurance

Committee on the Consequences of Uninsurance
Board on Health Care Services
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COMMITTEE ON THE CONSEQUENCES OF UNINSURANCE
MARY SUE COLEMAN (Co-chair), President, University of Michigan,
Ann Arbor
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 and 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
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
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
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, McColl Institute for Healthcare
Innovation, Center for Health Studies (CHS), Group Health Cooperative,
Seattle, Washington
LAWRENCE WALLACK, Director, School of Community Health, College
of Urban and Public Affairs, Portland State University, Oregon
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IOM Staff
Wilhelmine Miller, Project Co-director
Dianne Miller Wolman, Project Co-director
Lynne Page Snyder, Program Officer
Tracy McKay, Research Associate
Ryan Palugod, Senior Project Assistant
Consultants
Gerry Fairbrother, Research Director, Child Health Forum, New York
Academy of Medicine
Hanns Kuttner, Senior Research Associate, Economic Research Initiative on
the Uninsured, University of Michigan
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Foreword
Health Insurance Is a Family Matter is the third in a series of six reports planned
by the Institute of Medicine (IOM) and its Committee on the Consequences of
Uninsurance. This series of studies represents a major and sustained commitment
by the IOM to contribute to the public debate about the problems associated with
having more than 38 million uninsured people in the United States. This very
broad research effort also represents a significant contribution from The Robert
Wood Johnson Foundation for which we are grateful.
Health Insurance Is a Family Matter adds to the IOM’s history of related contri-
butions. Most relevant for this report on families is a consensus report issued by the
Committee on Children, Health Insurance, and Access to Care in 1998, America’s
Children: Health Insurance and Access to Care. That committee concluded that all
children should have health insurance. Because this has not yet become a reality,
the Committee on the Consequences of Uninsurance provides further evidence
and confirmation of the effects on children of being uninsured, as well as the
impact of uninsurance on the whole family.
As we prepared to issue the Committee’s first report last fall, Coverage Matters:
Insurance and Health Care, two hijacked airliners destroyed the World Trade Center
and another severely damaged the Pentagon. After the initial shock and recovery
began, attention turned to the families of the victims. Around the country people
began asking what could be done for families who had lost their health insurance
and their family’s income along with their loved ones. As the economy slowed
and more people lost their jobs, the fear of becoming uninsured grew and Congress
began debating what to do about the problem of health coverage interrupted by a
job loss. These circumstances make this report on the family effects of being
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viii FOREWORD
uninsured all the more important and relevant to current efforts to understand the
problem and find solutions.
The members of the Committee on the Consequences of Uninsurance are
experts in a wide range of disciplines, including clinical medicine, epidemiology,
health services research and delivery of services, economics, strategic planning,
small business management, and health communications. They carefully consid-
ered the pertinent evidence, and here present a coherent picture of the various
effects that being uninsured has upon family well-being.
This report shows that a family’s chance of having an uninsured member at
some point is significant and that a lack of coverage can have negative effects on
the uninsured child or pregnant woman. In addition, some of the ill effects of
uninsurance spill over to other family members, even if they have coverage, and
can jeopardize the family’s well-being and put the family unit at risk of financial
disruption. Children are our nation’s future, and families are the place for raising
and protecting them; it is crucial to the strength of the country that we consider
the contribution health insurance makes to family well-being. This report will
provide much material for reflection by policy experts, decision-makers, and the
general public as they consider the various ways that being uninsured can erode
the strength of America’s families—and what can be done about it.
Harvey V. Fineberg, M.D., Ph.D.
President, Institute of Medicine
September 2002
Preface
Health Insurance Is a Family Matter is the third report that the Institute of
Medicine (IOM) Committee on the Consequences of Uninsurance is issuing since
it began its research efforts in autumn 2000. Three more reports will be issued
before the completion of the project in 2003. These reports represent the
Committee’s efforts to review and assess the evidence concerning a wide range of
causes and effects of being uninsured. The Committee is concerned with both the
effects of lacking health insurance for individuals and the broader effects of having
more than 38 million uninsured people in our nation.
The Committee is following a carefully designed research plan so that each
report builds on previous ones and provides a foundation for future reports. The
first report, Coverage Matters: Insurance and Health Care, provides essential back-
ground information for understanding the dynamics of health insurance, who is
uninsured and why, and provides evidence to dispel many public misperceptions.
Coverage does indeed matter. The second report, Care Without Coverage: Too
Little, Too Late, presents an overwhelming body of evidence documenting the fact
that adults without insurance suffer worse health. Now the third report widens the
focus from the individual to the family.
Health Insurance is a Family Matter analyzes the effects being uninsured can
have on the health, finances and general well-being of the family. It also examines
the health of uninsured children and pregnant women to see whether they also
receive less care and suffer worse health outcomes than do those who are insured.
The next report will expand the focus of attention even more to examine how
having part of a community’s population uninsured can affect the community as a
whole, including those with insurance. Then the Committee looks at the eco-
nomic costs to society of sustaining an uninsured population of more than
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