Medical Issues Include Uninsured Workers and Inadequate Health Care
May 14, 2004 -- In many states, a large portion of workers do not have health care insurance, according to a recent report prepared for the nonprofit Robert Wood Johnson Foundation (RWJF). In six states, at least one in five working adults is uninsured. In 38 other states, at least one working adult in every 10 does not have health insurance. Nationwide, a total of 43.6 million Americans have no health care coverage (U.S. Census Bureau, September 30, 2003).
Uninsured workers are less likely to seek medical help or to have a personal doctor. They often miss out on preventive care. The figures are staggering--over 15 million uninsured adults without dental care, 27 million without flu shots, 3 million without mammograms, and 7 million without cancer screenings for prostate and cervical cancers. It comes as no surprise that those without health insurance are more likely to be in poor health than adults who have coverage. They may not go to a doctor until their symptoms are advanced, and even then, they may not be able to afford the expense.
Texas leads the nation in states with the highest rate of uninsured working adults (27%), followed by Louisiana (23%), Mississippi (22%) and New Mexico (22%). The states with the lowest rates are Minnesota (7%), Hawaii (7%), Maryland (8%), and Iowa (9%). The proportion of uninsured adults who live in households with at least one uninsured child is high.
More Blacks and Hispanics are uninsured than Whites. This is true, even in states that rated better in providing health insurance coverage to people overall. "Even states that have achieved a lot in terms of coverage have a way to go in terms of decreasing health [care] disparities," commented Lynn A. Blewett, Ph.D., principal investigator of the RWJF report. When asked what she hoped would be the main item to attract the attention of policy-makers, she replied, "...When you don't have access to preventive services before something becomes a real health problem, it will be costly. Other research has shown that, in the end, we all end up paying the costs for services that are delayed."
Health Care Conditions Among the Insured
Even among the insured, Americans may still not be getting the health care they need, according to another study, this one sponsored by the Rand Corporation. The researchers looked at the extent to which recommended care was provided to insured patients with various illnesses. They conducted telephone interviews of 13,000 adults in 12 cities, and reviewed 6,700 medical records. They considered clinical indicators of quality care for 30 chronic conditions such as diabetes, asthma, hypertension (high blood pressure), and heart disease.
According to the report results:
- Participants in the study received 55 percent of recommended care.
- Underuse of medical care was a greater problem than overuse of care.
- Quality of care varied according to the illness or condition. For example, people with cataracts received about 79 percent of recommended care while those with alcohol abuse problems received about 11 percent.
- The level of care for chronic conditions depended upon the nature of the condition as well as on the community. For example, the quality of care for high blood pressure was better than that for other chronic conditions, especially diabetes. Care for depression ranged from 47 percent of recommended care in Newark, NJ, to 63 percent in Seattle, WA.
Inadequate health care translates into thousands of preventable illnesses and deaths, the Rand report said. Less than one-quarter of diabetics had their average blood sugar levels measured regularly, for example. For a diabetic, poor control of blood sugar can lead to kidney failure and blindness. Patients with hypertension received less than 65 percent of recommended care. Poor blood pressure control is associated with increased risk for heart disease, stroke, and death.
Patients with pneumonia received just 39 percent of recommended care, and many were not vaccinated against the disease. Nearly 10,000 deaths from pneumonia could be prevented annually through proper vaccinations, the report said. Only 38 percent of adults were screened for colorectal cancer. Routine tests and appropriate follow-up could prevent 9,600 deaths a year for this disease.
"The study reveals substantial gaps between what clinicians know works and the care actually provided," the researchers concluded. They recommend better routine availability of information on health care performance at all levels. Suggestions include better automating the entry and retrieval of data to help in making decisions and to measure quality. They also recommend creating teams of doctors, nurses, and health educators, who will work together to ensure that patients get needed services.
How Does Health Care in the U.S. Compare with That of Other Nations?
The Rand study was published at about the same time as another health care study by the Commonwealth Fund, which focused on medical delivery systems in Australia, Canada, England, New Zealand, and the U.S. The Commonwealth Fund study found that asthma death rates for the U.S. have been increasing, while they have decreased in the other countries. The U.S. now has a higher asthma death rate than Australia or England. Kidney transplant five-year survival rates are lowest in the U.S., but its breast cancer five-year survival rates are highest among the five countries. Flu vaccination rates show that all five countries could prevent more flu-related deaths through vaccination. The purpose of the study was to allow countries "to benchmark their progress against each other, find areas of medical care where they might learn from each other, and also raise red flags where health systems are falling behind."
How to Obtain These Health Care Reports
Information about the Commonwealth report on international health care systems is on the group's web site. You will need Adobe Acrobat software to access this report. If you do not have Adobe Acrobat installed on your computer, or need to upgrade your version of the software, you may download a free copy from the Adobe web site.
The RWJF report on uninsured U.S. workers is based on data from the federal Centers for Disease Control and Prevention's 2002 Behavioral Risk Factor Surveillance System Survey. Researchers at the State Health Access Data Assistance Center, located at the University of Minnesota, prepared the report for the Robert Wood Johnson Foundation.
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