Large Number of Uninsured Can Affect Entire Community’s Access to Medical Care, IOM Report Says

A large number of uninsured residents in a community can affect access to care for the entire community, according to an Institute of Medicine report released March 6, the AP/Detroit News reports (Schmid, AP/Detroit News, 3/7). The report, "A Shared Destiny: Effects of Underinsurance on Individuals, Families, and Communities," found that communities with high rates of uninsured residents are more likely to reduce hospital services, to take resources from disease prevention and surveillance programs and to reallocate tax revenue to cover the cost of uncompensated care (Institute of Medicine release, 3/6). The report also found that large numbers of uninsured residents in a community can lead to overcrowded emergency rooms and trauma care centers, which may prompt the facilities to close (AP/Detroit News, 3/7). In addition, physicians in communities with a high rate of uninsured residents may limit their availability to patients. "For example, some specialists in Phoenix have ended affiliations with certain hospitals, or refused to offer on-call services, in part to avoid treating uninsured patients for whom they do not expect to be reimbursed," the report said (Fox, Reuters/Detroit Free Press, 3/7). The report also found that the presence of uninsured residents in a community can have a more "direct effect" on the health of others in the community. According to the report, for example, 20% of individuals with HIV do not have health insurance, and many remain unaware of their conditions because they do not receive regular care, which makes them more likely to transmit HIV to others(Institute of Medicine release, 3/6).

Analysis
Dr. Arthur Kellermann, professor and chair of the Emory University School of Medicine and co-chair of the IOM committee that prepared the report, said, "It is mistaken and dangerous to assume that the prevalence of uninsurance in the United States harms only those who are not insured" (AP/Detroit News, 3/7). The IOM released the report one day after the release of a study prepared by Families USA for the Robert Wood Johnson Foundation that found an estimated 75 million U.S. residents younger than 65 lacked health insurance for at least part of 2001 or 2002 (Kaiser Daily Health Policy Report, 3/5). An abstract of the IOM report is available online. Note: You must have Adobe Acrobat Reader to view the abstract.

A Web cast of the IOM briefing to release the report is available online at kaisernetwork.org. In addition, a Web cast of the RWJF briefing to launch the Cover the Uninsured Week is available online.