Trends in the Uninsured: Impact and Implications of the Current Economic Environment Samuel Zuvekas, Ph.D. Senior Economist Agency for Healthcare Research and Quality

Implications of Being Uninsured Access to care Access to care Health outcomes Health outcomes Financial impact for families and individuals Financial impact for families and individuals Burden on the delivery system Burden on the delivery system

Access Problems No regular or usual source of care No regular or usual source of care Difficulties and delays in getting care Difficulties and delays in getting care Health care use Health care use

Percent of under 65 Population with No Usual Source of Care Source: Weinick, Zuvekas & Drilea, MEPS Research Findings #3

Percent of Families Experiencing Difficulties, Delays, or Unmet Need Source: Weinick, Zuvekas & Drilea, MEPS Research Findings #3

Health Outcomes Preventive care Preventive care Care for chronic conditions (e.g. diabetes, hypertension, HIV/AIDS) Care for chronic conditions (e.g. diabetes, hypertension, HIV/AIDS) Process vs. Outcomes Process vs. Outcomes IOM Report IOM Report

Preventive Care Services Source: Taylor, Cohen, & Machlin (2001)

Financial Impact Pay out of pocket, no insurance discounts Pay out of pocket, no insurance discounts Financial burden relative to income Financial burden relative to income Catastrophic illnesses Catastrophic illnesses

Percent of Families with High Out of Pocket Burden* Source: Taylor, Cohen, & Machlin (2001) *Greater than 20 percent of family income

Burden on the Delivery System Charitable care Charitable care Public financing Public financing Cost-shifting Cost-shifting Inefficient use Inefficient use

Percent of under 65 Population with No Usual Source of Care Source: Zuvekas and Weinick (1999)

Percent of Children Under 18 with No Usual Source of Care Source: McCormick et al (2000)

Access Problems of the Insured Incomplete coverage Incomplete coverage Non-financial barriers Non-financial barriers Disparities Disparities

Effects of Health Insurance and Income on Health Disparities Source: Weinick, Zuvekas, & Cohen (2000) Usual Source of CareAny Ambulatory Care

Health Care Spending in the under 65 Population, 1996 Source: Cohen, Machlin, Zuvekas, et al., MEPS Research Findings #12

Health Care Spending for Children Aged 17 and Younger, 1996 Source: McCormick et al. (2001)