The changing profile of the urban uninsured: exploring implications of rise in the number of moderate-income uninsureds

The impacts of subsidized health insurance on employees' use of preventive health services

This study presents an uncontrolled preliminary evaluation of a pilot health insurance subsidy program and addresses whether provision of subsidized insurance that required employee contribution had an impact upon preventive health utilization among small businesses and their employees. Self-report questionnaires were mailed to the employees; these included questions on use of preventive health services before and after enrollment in the subsidy program. The analysis was stratified by self-reported prior enrollment in an insurance program to compare employees with and without prior health insurance. The findings suggest significant increases in health service utilization among the previously uninsured. Regular checkups more than doubled (p < .0001), as did the number of individuals receiving regular blood work (p < .0001). Nearly twice the number of individuals filled regular prescriptions after enrollment in the subsidy program as compared with before (p < .0001). This study suggests that employees of small businesses are willing to contribute to the cost of a health insurance premium, and once insured are more likely to use preventive services. A model of shared cost responsibility is an effective way to provide affordable insurance to small-business employees, thus increasing preventive services in these populations.

How does lack of insurance affect use of intensive care? A population-based study

OBJECTIVE

One in six Americans aged <65 yrs are without health insurance. Although lack of insurance is associated with reduced access to many health services, the relationship between lack of insurance and use of intensive care services is unclear. We sought to compare the use of intensive care by insured and uninsured populations.

DESIGN

Retrospective population-based cross-sectional study of five U.S. states (Florida, Massachusetts, New Jersey, New York, and Virginia), analyzing use of hospital and intensive care unit (ICU) services by all residents of these states <65 yrs of age. Data sources included the five 1999 state hospital discharge databases and the 2000 U.S. Census Bureau Current Population Survey.

SETTING

Nonfederal hospitals in the five states (all hospitalizations in these during 1999).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There were 39.3 million and 7.8 million individuals aged 0-64 yrs with and without insurance, respectively, in the five-state sample. The uninsured population was far less likely to be hospitalized (odds ratio [OR], 0.458; 95% confidence interval [CI], 0.456-0.460; p < .001) and to be admitted to the ICU (OR, 0.581, 95% CI: 0.576-0.587, p < .001). Differences persisted irrespective of age, gender, ethnicity, or reason for admission. Among those hospitalized, the uninsured were more likely to receive intensive care (OR, 1.24; 95% CI, 1.22-1.25; p < .01). Hospital mortality rates for patients admitted to the ICU ranged by age from 4.0% to 6.9% for the uninsured and from 2.7% to 5.5% for the insured (OR, 1.12-1.54; p < .01).

CONCLUSIONS

Americans without insurance use ICU services less often than those with insurance, primarily because of decreased likelihood of hospital admission in the first place. Outcome is worse for those who are admitted to the ICU, possibly because they are sicker when they seek care.