Insuring America's Health Principles and Recommendations (2004) / Chapter Skim
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1. Introduction
1. Introduction
Pages 15-29
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From page 15... ...
1The estimate of 39.4 million uninsured is based on the Census Bureau's March Current Population Survey (CPS) as are all annual estimates of the uninsured population of the United States presented in this report, unless otherwise noted.
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16 Cal o o Cal o ~ _ CD _;~ o o ~ Cal o _ to Lo -1 .~!
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. Many states are proposing or implementing cost containment measures for public coverage programs, although few have yet to cut eligibility substantially or covered services for their Medicaid and State Children's Health Insurance Programs (SCHIP)
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Therefore, this sixth and final report draws on the findings of the previous five reports, as well as an examination of selected historical efforts and federal, state, and local programs that were designed to extend coverage. The Committee uses the term "extend coverage" to mean having more people gain coverage who previously had had none and reducing the uninsured rate.
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19 z el: N z el: U)
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The Committee concludes that allowing a sizable uninsured population to persist has serious negative consequences for individuals, families, communities, and the entire nation. Collectively, these five reports show that current insurance mechanisms have not eliminated the large, persistent uninsured population and indeed are not structured to do so.
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Health insurance is defined by the Committee as financial coverage for basic hospital and ambulatory care services, whether provided through employment-based indemnity, service-benefit, or managed care plans; individually purchased health insurance policies; public programs such as Medicare (which covers virtually all persons 65 years of age and older) , Medicaid, and the SCHIP; or other state-sponsored coverage for specified populations.
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Lowering financial barriers to needed health services is one important improvement to achieve this goal. Table 1.1 includes health system and health status indicators of the United States and several other developed, high-income countries.4 Several conclusions can be drawn from this table and the comparative international literature reviewed: 1.
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For example, the United States was quicker to adopt and diffuse new technologies involved with care of heart attack patients than most of the 17 other developed countries studied (TECH Research Network, 2001~. The number of coronary ang~oplasties in the United States per 100,000 population is more than two times that in Germany and even further ahead of Australia, Canada, New Zealand, and England.
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The United States came in last for three indicators (low birth weight; neonatal mortality and infant mortality overall; years of potential life lost) , even after excluding external causes such as motor vehicle collisions and violence.
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Public coverage programs are targeted to specific subsets of the population; regulation of private insurance varies substantially by state and is constrained by federal and state laws; private employment-based coverage depends on the types of businesses in the area as well as economic conditions; and no single agency or person has responsibility for pulling together the pieces to ensure coverage for the whole population. Nonetheless, for convenience this report will use the term "health insurance system when it refers broadly to the issues, players, and programs mentioned above that relate to financial access to care.
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The Committee recognizes as important certain evidence-based principles that describe characteristics of an effective health insurance system, regardless of its particular structure. The principles can be used to examine current proposals to extend health insurance coverage and to help develop new approaches that would combine the best of existing ideas or break new ground.
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In the sixth and last chapter, the Committee presents its recommendations concerning health insurance. They are based on the findings in Chapter 3 concerning coverage extensions and those enumerated in Chapter 2, and on the
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INTRODUCTION 29 findings and conclusions in the Committee's previous five reports. The recommendations also articulate fundamental shared values across the diverse Committee membership.
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