|February 15, 2002
Highlight Perils of Nation's Uninsured
This week the Association of Academic Health Centers (AHC) refocused the nation's
attention on the plight of the uninsured.
That's because, although academic medical centers make up only 6 percent of the
nation's hospitals, they provide health care services to nearly half of the nation's
uninsured patients. "It's a tremendous problem for us," said Dorothy Bainton,
vice chancellor for academic affairs at UCSF.
Bainton's remarks launched the Feb. 4 symposium titled "Why Not Everyone? It's
Time for Action on the Uninsured." The event was one of many held across the country
prior to the Feb. 12 start of the national campaign. The UCSF symposium was held in the
School of Nursing auditorium and was hosted by AHC, the UCSF Center for Health and
Community and Philip R. Lee Institute for Health Policy Studies.
In all, eight faculty members presented their research. They illustrated the scope of
the problem, reviewed the solutions being considered and described non-financial barriers
faced by the uninsured.
More than seven million Californians are without health insurance. Nationwide, an
estimated 42 million people are uninsured. "We're the only industrialized country
without universal or near-universal health coverage," said Hal Luft, director of the
Philip R. Lee Institute for Health Policy Studies and a professor of health policy and health economics.
The hospitals associated with UCSF directly provide care for people without health
insurance. In addition, Luft added, UCSF is a major research site looking at why people
don't have coverage and the implications for the uninsured themselves, the health care
system and society as a whole.
Several of the speakers highlighted the non-random nature of the demographics of the
uninsured. Thanks to recent efforts, a large percentage of children are insured, reported
Paul Newacheck, professor of health policy and pediatrics and co-director of the MCH
Policy Research Center located here and in Washington, DC. Despite the seemingly
encouraging percentage, the fact is that 10 million nationwide are uninsured. Most
uninsured kids, however, are eligible for health coverage under existing programs, but
this requires patents to enroll them. "Many families don't think their children are
eligible or they are unaware of the programs."
The situation is even more striking when it comes to dental care, said Jane Weintraub,
director of the Center to Address Disparities in Children's Oral Health. An astonishing 23
million children nationwide do not have dental coverage, said Weintraub, also professor
and chair of the division of oral epidemiology and dental public health in the school of
dentistry. "Only 36 percent of the children living below the poverty line have
visited the dentist in the previous year."
Likewise, the poor and members of racial and ethnic minority groups are more likely to
be uninsured. Employment has a lot to do with whether or not a person has health coverage.
And, those who work in the service industries or for small businesses are less likely to
be covered. In San Francisco, coverage of children isn't the big issue, said Andrew
Bindman, chief of the division of general internal medicine at San Francisco General
Hospital Medical Center. "San Francisco County has the highest rate of uninsured
adults in the state at 34 percent."
Several researchers are looking at whether health coverage can indeed erase the health
disparities seen in this country based on race, ethnicity and socioeconomic status.
"Insurance may not address cultural beliefs, language and communication barriers and
environmental effects," said Jennifer Haas, associate professor of medicine. Giving a
person insurance coverage will not remedy the years that person went without comprehensive
and preventive health care, Haas added.
Bindman and others agreed that the problem of the uninsured is likely to worsen in the
coming years. "As our economy declines, the number of uninsured will continue to
grow." A lack of coverage leads to a decline in the use of medical services, Bindman
explained. And that leads to an increase in the prevalence of otherwise preventable
diseases, the presentation of diseases at later, less treatable stages and a general
decline in other indicators of public health. "There are real health consequences of
not having health care coverage. Anyone who doesn't think so isn't looking closely enough
at the data."
Camille Mojica Rey