What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA

The uninsured What safety net? 33 million uninsured in % of people were uninsured at the time of the call. 9.7% were uninsured for >1 year. 4.3% were uninsured for <1 year. Ayanian JZ, et al. JAMA 2000;284(16):

Long-term uninsured What safety net? Uninsured by annual income: $0 - 15,000: 36.0% $15,000 – 24,999: 27.5% $25,000 – 34,999: 14.4% $35,000 – 49,999: 6.5% $50,000 – 74,999: 3.7% $75,000+: 2.4%

Chronic diseases What safety net? Patients without a checkup in the last 2 years Uninsured > 1 year:42.8% Uninsured < 1 year:22.3% Insured:17.8%

Holes in the net? What safety net? Options vary widely from state to state, region to region. Emergency rooms are “treatment centers of last resort” but aren’t well equipped to manage chronic diseases.

Through the cracks What safety net? Most uninsured Americans work, but their wages are too low to get insurance. We need to offset cost for individuals and for small businesses.

The European model What safety net? In the US, the 80-85% with insurance have access to excellent basic care. The 15-20% without do not have adequate access to care. The rest of the western nations, almost all have at least access to adequate care.

Solutions What safety net? Recognize the magnitude of the long-term problem. Need bipartisan support and partnership. State governments must be involved. All Americans need access to a basic level of care.

Regional differences What safety net? Census region% Uninsured Northeast11.4 South16.9 Midwest 9.8 West16.0

The study What safety net? Unmet Health Needs of Uninsured Adults in the United States Ayanian JZ, et al. JAMA 2000;284(16):