Table Of ContentCommittee 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, 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, University of Mississippi Medical
Center, School of Nursing, Jackson
GEORGE C. EADS, Charles River Associates, Washington, DC
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 and CEO, Partners HealthCare, Inc.,
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
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, MacColl Institute for Healthcare
Innovation, Center for Health Studies, Group Health Cooperative, Seattle,
Washington
LAWRENCE WALLACK, Director, School of Community Health, College
of Urban and Public Affairs, Portland State University, Oregon
*Served from September 2000 to December 2002.
v
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
Consultant
Cheryl Ulmer, Writer
*
Served until August 2003.
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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 National Research Council’s Report Review Committee. The
purpose of this independent review is to provide candid and critical comments
that will assist the institution in making its published report as sound as possible
and to ensure that the report meets institutional standards for objectivity, evi-
dence, 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 following individuals for their review of this report:
Sheila Burke, Smithsonian’s Under Secretary for American Museums and
National Programs, Smithsonian Institution, Washington, DC.
Robert Cunningham, Deputy Editor, Health Affairs, Bethesda, MD.
Helen Darling, President, Washington Business Group on Health,
Washington, DC.
Michael M. E. Johns, Executive Vice President for Health Affairs, Emory
University, Atlanta, GA.
Charles N. Kahn, III, President, American Federation of Hospitals,
Washington, DC.
Catherine McLaughlin, Director, Economic Research Initiatives on the
Uninsured, University of Michigan, Ann Arbor.
Mark Pauly, Bendheim Professor, The Wharton School, University of
Pennsylvania, Philadelphia.
Trish Riley, Executive Director, National Academy for State Health Policy,
Portland, ME.
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viii REVIEWERS
Diane Rowland, Executive Vice President, Kaiser Family Foundation,
Washington, DC.
Leonard Schaeffer, Chief Executive Officer, WellPoint Health Networks,
Inc., Thousand Oaks, CA.
Rosemary Stevens, Stanley I. Sheerr Professor in Arts and Sciences, Emerita,
University of Pennsylvania, Philadelphia.
Although the reviewers listed above have provided many constructive com-
ments and suggestions, they were not asked to endorse the conclusions or recom-
mendations nor did they see the final draft of the report before its release. The
review of this report was overseen by Hugh H. Tilson, Clinical Professor,
School of Public Health, University of North Carolina, Chapel Hill, and
Joseph P. Newhouse, John D. MacArthur Professor of Health Policy and
Management, Harvard University. Appointed by the National Research
Council and Institute of Medicine, they 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.
Foreword
Insuring America’s Health: Principles and Recommendations concludes the series of
groundbreaking reports by the Institute of Medicine and its Committee on the
Consequences of Uninsurance. The previous five Committee reports, issued be-
tween October 2001 and June 2003, have established both a broader conceptual
framework and a new empirical evidence base with which to assess the implica-
tions of our nation’s policies regarding health insurance and of the lack of coverage
for one out of every seven Americans.
Beginning with Coverage Matters, which dispelled common misconceptions
about who lacks health insurance, why, and the access implications of being
uninsured, the Committee’s reports examine multiple facets of the problem of
uninsurance and systematically address questions relevant for public policy. Care
Without Coverage: Too Little, Too Late documents the serious health risks that the
lack of coverage poses for adults. Health Insurance Is a Family Matter extends this
examination of health outcomes to those of pregnant women and infants and
children, and considers the psychosocial and financial impacts that the lack of
health insurance for any family member has on the whole family. The Committee’s
fourth report, A Shared Destiny: Community Effects of Uninsurance, extends the
scope of analysis even further, to conceptualize and determine how the presence
of uninsured residents might affect the health, health care, and social and eco-
nomic life of neighborhoods, towns, cities, and rural areas. Notably, this report
includes an original study of community-level effects of uninsurance on the avail-
ability of hospital services and hospital financial margins. In Hidden Costs, Value
Lost, its fifth report, the Committee presents an innovative assessment of the
economic implications of the lack of health insurance across society. This analysis
considers the economic value lost to the nation in terms of the poorer health and
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