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Expanding Health Insurance To Uninsured Could Narrow Access And Quality Gaps For People With Coverage, New Study Finds


Health Affairs Issue Focuses On Vulnerable Populations, Factors That Contribute To Poor Health, How To Improve Immigrant Care, And Policies To Address Disparities

Bethesda, MD -- Expanding coverage to the forty-seven million Americans who now lack health insurance could greatly improve care for people who already are protected, according to a new study in the September-October issue of the journal Health Affairs. Researchers found that insured adults who live in communities with high uninsurance rates are more likely to face problems with access to care and quality than those who live in communities where more people are covered. http://content.healthaffairs.org/cgi/content/abstract/26/5/1304

Economists Mark Pauly and José Pagán compared differences in health care access, use, and quality between 9,552 insured adults in ten communities with the highest and ten with the lowest proportions of uninsured adults. Communities with high rates of uninsurance had an average of about 27 percent of adults without health insurance. Communities with low rates of uninsurance had an average of nearly 7 percent of adults who lacked coverage.

The authors found that insured adults who live in communities with high proportions of uninsured people were less likely to have a place to go when they were sick or needed health care advice, less likely to visit a doctor, and less likely to have had a physician exam within the last year, compared with their peers in low-uninsurance communities. They also reported more problems getting referred to a specialist and were less likely to report that they were satisfied with their doctor, according to Pauly, a professor at the Wharton School at the University of Pennsylvania, and Pagan, professor and director of the Institute for Population Health Policy at the University of Texas-Pan American.

What’s In The Issue. The study is one of many papers focusing on vulnerable populations and health that appear in the September-October issue of Health Affairs, a thematic issue titled “Caring For The Vulnerable” and supported by an unrestricted grant from the Robert Wood Johnson Foundation. http://content.healthaffairs.org/current.shtml

Other articles on vulnerable populations include the following:

Early-Life Conditions And Health Status. Scholars have only begun to identify how factors such as socioeconomic status, neighborhood environments, and traumatic events in childhood can affect health over the course of a lifetime. Researchers from the Center for Interdisciplinary Health Disparities Research, University of Chicago, explain that policies and programs are more effective if they target neighborhoods and address multiple factors, including children’s physiological and cognitive development and social inequality, rather than focusing exclusively on health. These programs and policies have a greater chance of long-term success if they include input from community stakeholders, said the authors. http://content.healthaffairs.org/cgi/content/abstract/26/5/1238

“The Katrina disaster exposed the extreme vulnerabilities of a population group defined by poverty, racial discrimination, and geography and focused a global spotlight on the consequences of policies that fail to acknowledge and address those vulnerabilities,” write Alice Furumoto-Dawson and coauthors. “When it comes to population-based health vulnerabilities, there is no such thing as ‘benign’ neglect.”

Health Care And Immigrants. RAND’s Kathryn Derose and coauthors explore the factors that affect immigrants’ health status. Although there are differences among immigrant subgroups, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than those born in the United States. To addresses these issues, the researchers call on policymakers to expand access to health insurance for immigrants, address limited English proficiency, implement policies that strengthen the safety-net infrastructure, and consider easing access to public health insurance. http://content.healthaffairs.org/cgi/content/abstract/26/5/1258

Consumer-Directed Health Care And Vulnerable Populations. Gregg Bloche, a professor at the Georgetown University Law Center, argues that consumer-directed health plans -- those that pair high-deductible health plans with health care savings accounts (HSAs) -- could widen socioeconomic, racial, and ethnic disparities in care. Possible fixes to such plans include more-progressive tax subsidies, tiering of cost-sharing schemes to promote high-value care, and reducing deductibles and copayments for the less well-off. “Copayments and deductibles should not force desperate families to choose between high-value health care and life’s other basic needs,” he writes. http://content.healthaffairs.org/cgi/content/abstract/26/5/1315

Other Issue Highlights:

Health Spending In The U.S And Other Industrialized Countries. “In 2004, the U.S. health care system continued to provide less access to health care resources than the health systems in many other [industrialized] countries; however, the United States continued to have the highest level of spending,” Gerard Anderson of Johns Hopkins and coauthors report. Per capita U.S. health spending was $6,102, about 2.5 times greater than median spending in 2004 -- the most recent year for which standardized international data are available -- for the countries in the Organization for Economic Cooperation and Development (OECD). As in prior years, higher U.S. spending stemmed primarily from the country’s relatively high per capita gross domestic product (GDP) and “the much higher prices that Americans pay for health care services.” http://content.healthaffairs.org/cgi/content/abstract/26/5/1481

The authors observe that chronic disease accounts for 80 percent of health care use in most OECD countries. Five of the most common chronic diseases account for half to two-thirds of all causes of mortality in high-income countries. The relatively high chronic disease prevalence and mortality in the United States “may be associated” with the high number of Americans who are overweight and obese. Tobacco and alcohol consumption per capita in the United States, also tied to chronic disease risk, was below the OECD median for each.

Employer-Sponsored Health Benefits. Premiums for employer-sponsored health coverage rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent), Kaiser Family Foundation vice president Gary Claxton and coauthors report in an article based on the 2007 Employer Health Benefits Survey conducted by Kaiser and the Health Research and Educational Trust. http://content.healthaffairs.org/cgi/content/abstract/26/5/1407

The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Although premiums continue to rise faster than workers’ wages, this year’s gap of 2.4 percentage points is much smaller than the 10.9-percentage-point gap recorded four years ago, when premiums rose 13.9 percent and wages grew just 3 percent.

However, “despite the comparatively low rate of increase in premiums and a strong labor market, the percentage of the workforce obtaining coverage from employer-sponsored plans remained unchanged since 2006,” the authors say. The 60 percent of firms offering health benefits to at least some of their workers in 2007 was statistically unchanged from 2006 but was significantly lower than the 69 percent of firms that offered health benefits in 2000.

ABOUT HEALTH AFFAIRS:

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.

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©2007 Project HOPE–The People-to-People Health Foundation, Inc.