Despite advances in medicine over the last few decades , access to care remains as abysmal as before. Although most individuals in my nation (USA) do receive benefits of some form, and have primary care physicians at their disposal, there remains a disparity among millions who are not insured. Without insurance, even the most basic treatments can be prohibitively expensive. With the recent financial meltdown across the globe, many of the issues we face in the United States have been magnified.
What is life like in the United States without health insurance?
The lack of insurance coverage (whether it is provided publicly or through private insurance companies) decreases the likelihood of receiving preventive health services such as consultations and planning, and diagnostic services [1]. Preventive care is important because insured individuals are 50% less likely to see null results in biopsies, when tested [2]. This has impacted the health and quality of life of many Americans since the inception of modern evidence-based medicine, because even though quality care has been available for a long time, the issue that often keeps longevity in our nation low is access to services. Hospital mortality is 1.2 to 3.2 times higher among the uninsured compared to privately insured individuals [3]. What’s more, improved health has been associated with an increase in an individual’s income by 15%-20%. Whether this is correlative or cause-and-effect has yet to be determined.
However, this is not just an issue that affects a subset of the population; the vitality of an individual can also affect the whole health care system. The uninsured are more likely to seek care in outpatient clinics and emergency departments (29%-75% are less likely to undergo procedures [3], possibly because of cost)[4], ultimately increasing the patient’s out-of-pocket expenses and putting unnecessary burden on the emergency health services that are often over-capacity and unable to provide the high level of patient care that is often expected, as a result. In addition to capacity issues, hospitals may never be reimbursed for their services, but are simply expected to absorb the cost associated with the care.
In 1990, 34.7 million people were without insurance in the United States [5]. With a population of 248.7 million at the time [2], this is 13.95 percent of the nation who could otherwise be receiving top-notch care. This is in contrast to the 2010 data showing an increase in uninsured individuals to 49.9 million people [6] with a population of 308.4 million[7]. This is 16.18 percent of the country, an increase of 2.23 percent over the past 20 years. Obviously, the recent recession may have contributed to this detrimental change because at the turn of the century, the uninsured population decreased to 33 million adults with a population of 270.3 million (12.2 percent) [8].
The demographic differences between 1990 and 2010 have been for the most part unchanged among the uninsured. However, the recession has exaggerated the differences somewhat. The highest uninsured population has historically been Hispanics, with 26.1% uninsured in 1990 and rising to 33.9% in 2010. The black population has been the next largest to be uninsured, with 12.4% in 1990 and 22.6% in 2010. This clearly shows disparity among different racial groups, since the white population has continued to be the least likely of the three to be uninsured with 9.3% in 1990 and 14.1% in 2010 [4] [9].
Age is also an important category, since young adults (between 18 and 25) are far less likely to carry health coverage. This is possibly due to the nature of their work as they begin their careers, or any other of several factors such as being less likely to have health problems. Although, the young adult population has seen the most dramatic increase in lacking coverage, from 19.9% (18-25 year olds) in 1986, evenly distributed among males and females [4], to 40% among men and 19.9% among women in 2009 [9].
This dismal picture of health care disparity can stop any reader in their tracks. Not only is the lack of access left wanting in the United States even more then it was 20 years ago, but the disparity is not uniform among the national population. This shows some clear, and persistent, racial divides among working individuals and how medical treatment is distributed.
Given the decline in insurance coverage, legislators have proposed several solutions over the past few years to address this issue in the recession stricken nation. Although national health care remains elusive and a distant dream, measures have been recently implemented to increase coverage for individuals who cannot afford insurance, and force many employers to offer benefits to uninsured workers. What this means for the quality of care, and how a sudden influx of newly insured persons will change the current system remains to be seen.
About the Author
Anton S. Power received his Bachelors of Science in Biochemistry from the California State University-East Bay, after which he interned and subsequently worked at the Lawrence Livermore National Laboratory as a research associate at the Bioscience and Biotechnology Division.
He is an incoming medical student at the University of New England College of Osteopathic Medicine (Fall 2013), and currently works at ZELTIQ Aesthetics as a Clinical Data Specialist in Pleasanton, California, USA.
His is also an active blogger, and a gourmet food and physical fitness enthusiast.
Editor’s Note: This is a guest post and the views expressed in the article are solely that of the author. The incidents about patient experiences stated in this blog are completely fictional and any resemblance to any person(living or dead)and/or incident is purely co-incidental.
References
[1] Hadley, J. (2003). Sicker and poorer—the consequences of being uninsured: A review of the research on the relationship between health insurance, medical care use, health, work, and income . Medical Care Research and Review, 60(2), 3S-75S. Retrieved from http://mcr.sagepub.com/content/60/2_suppl/3S.short
[2] U.S. Census Bureau, (n.d.). Population change and distribution (C2KBR/01-2). Retrieved from website: http://www.census.gov/prod/2001pubs/c2kbr01-2.pdf
[3] Hadley, J., Steinberg, E. P., & Feder, J. (1991). Comparison of uninsured and privately insured hospital patients. Journal of the American Medical Association, 265(3), 374-379. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=384770
[4] Freeman, H. E., Aiken, L. H., Blendon, R. J., & Corey, C. R. (1990). Uninsured working-age adults: characteristics and consequences. Health Services Research, 24(6), 811-823. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065602/?page=6
[5] Himmelstein, D. U., Woolhandler, S., & Wolfe, S. M. (1992). The vanishing health care safety net: new data on uninsured americans. International Journal of Health Services, 22(3), 381-396. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1644504
[6] U.S. department of health and human services. (2011, September 13). Retrieved from http://aspe.hhs.gov/health/reports/2011/CPSHealthIns2011/ib.shtml
[7] Schlesinger, R. (2009, December 30). U.s. population 2010: 308 million and growing. Retrieved from http://www.usnews.com/opinion/blogs/robert-schlesinger/2009/12/30/us-population-2010-308-million-and-growing
[8] npg.org. (1999, Jun 04). Retrieved from http://www.npg.org/facts/us_historical_pops.htm
[9] Fronstin, Paul , Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2010 Current Population Survey (September 1, 2010). EBRI Issue Brief, No. 347, September 2010. Available at SSRN: http://ssrn.com/abstract=1682249
Image Courtesy: http://pixabay.com/en/money-wings-eco-48103/ Under Creative Commons License Public Domain Image
