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If common childhood conditions such as asthma, anemia, and middle-ear infections are left untreated or improperly controlled — which can happen if a family lacks insurance — they can affect mental and language development, school performance, and hearing.
In 1996 and 1997, 15 percent of uninsured pregnant women never went to the doctor before giving birth, compared with 4 percent of
women with private or public coverage. Figure 2 outlines the related consequences: more low-birth-weight babies and increased infant mortality. Coverage is related to better outcomes.
People with any kind of health insurance are more likely to receive screening services than are those with no coverage. Chronically ill people, (e.g., those with hypertension, diabetes,schizophrenia) who have health insurance are more likely to receive appropriate care than those who are uninsured.
Uninsured people are more likely to require expensive crisis care in emergency rooms or hospitals for conditions that would have been responsive to earlier, more appropriate ambulatory care. For instance, uninsured patients are more likely to develop severe, uncontrolled hypertension that requires emergency hospital admission. Having coverage can promote receipt of high-quality care.
The uninsured are less likely than their insured counterparts to receive recommended preventive and screening services, or
medicines and treatments that meet the professional standard, including medications for depression, revascularization for acute myocardial infarction, and breast-conserving surgery with mastectomy.
Having a regular provider of care, particularly for primary care and chronic conditions, is considered a predictor of quality. Uninsured children were more than three times as likely as children with Medicaid coverage to have no regular source of care (15 percent vs. 5 percent), and uninsured adults were more than three times as likely as those with public or private insurance to lack a regular source of care (35 percent vs. 11 percent).
Uninsured adults with
chronic diseases are less likely to receive evidence-based, recommended care for their condition than those who have health insurance. For example, uninsured adults with diabetes are less likely to receive recommended regular foot or eye exams, which can prevent foot ulcers and blindness. Providing health insurance is cost-effective for society.
The economic value to be gained in terms of better health outcomes once those now uninsured become insured would likely exceed the additional costs of providing them with same level of services used by those with public or private coverage.
If all uninsured individuals gained coverage, the estimated costs for their increased use of services range from $34 billion to $69 billion, which is between 3 percent and 5.6 percent of national spending for personal health care services in 2001.
Drawn from: Coverage Matters, 2001; Care Without Coverage, 2002; Health Insurance Is a Family Matter, 2002; Hidden Costs, Value Lost, 2003; Insuring America’s Health, 2004; Institute of Medicine, Washington, D.C.: National Academies Press.
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