difficulties in obtaining access to timely and appropriate care (Sorvillo et al., 1999; Kates and Sorian, 2000; IOM, 2002a). Persons who are HIV positive and uninsured are also more likely to be unaware of their infectious state than are seropositive persons with health insurance, either public or private (Bozzette et al., 1998).


The Committee draws two conclusions based on its expert judgement and the sufficiency of the evidence base.

  1. A community’s high uninsured rate has adverse consequences for the community’s health care institutions and providers. These consequences reduce access to clinic-based primary care, specialty services, and hospital-based care, particularly emergency medical services and trauma care.

  2. Research is needed to more clearly define the size, strength, and scope of adverse community effects that are plausible consequences of uninsurance. These include potentially deleterious effects on access to primary and preventive health care, specialty care, the underlying social and economic vitality of communities, public health capacity, and overall population health.

What we don’t know can hurt us. There is much that is not understood about the relationships between health services delivery and financing mechanisms and even less about how the current structure and performance of the American health care enterprise affect communities’ economies and the quality of social and political life in this country. Because policy makers and researchers have not asked or examined these questions through comprehensive and systematic research and analysis, there is a limited body of evidence of mixed quality on community effects.

The Committee believes, however, that it is both mistaken and dangerous to assume that the prevalence of uninsurance in the United States harms only those who are uninsured. It calls for further research to examine the effects of uninsurance at the community level but nonetheless believes there is sufficient evidence to justify the adoption of policies to address the lack of health insurance in the nation (Corrigan et al., 2002). Rather, the call for more research is to say that, as long as we as a nation tolerate the status quo, we should more fully understand the implications and consequences of our stalemated national health policy.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement