Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital--based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million -- one in seven--working--age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE CONSEQUENCES OF UNINSURANCE
• Reviewers
• Foreword
• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • SCOPE OF THE REPORT
  • DEFINITIONS
  • A CONCEPTUAL FRAMEWORK FOR UNDERSTANDING THE EFFECTS OF HEALTH INSURANCE STATUS
  • ORGANIZATION OF THE REPORT
• 2. Mechanisms and Methods: Looking At the Impact of Health Insurance on Health
  • MECHANISMS AND MEASURES OF ACCESS TO HEALTH CARE
  • METHODOLOGY AND MEASUREMENT OF HEALTH INSURANCE EFFECTS
  • METHODS OF THE SYSTEMATIC LITERATURE REVIEW AND SYNTHESIS
• 3. Effects of Health Insurance on Health
  • PRIMARY PREVENTION AND SCREENING SERVICES
  • CANCER CARE AND OUTCOMES
  • CHRONIC DISEASE CARE AND OUTCOMES
  • HOSPITAL-BASED CARE
  • GENERAL HEALTH OUTCOMES
  • CONCLUSION
• 4. The Difference Coverage Could Make to the Health of Uninsured Adults
  • ADULTS MOST AT RISK OF POOR HEALTH
  • FEATURES OF HEALTH INSURANCE THAT IMPROVE HEALTH-RELATED OUTCOMES
  • INSURING THE UNINSURED: IMPROVING HEALTH OUTCOMES
• A A Conceptual Framework for Evaluating the Consequences of Uninsurance: A Cascade of Effects
• B Primary Research Literature Review
• C Glossary and Acronyms
• D Estimates of Excess Mortality Among Uninsured Adults
• E Biographical Sketches
• References

Support for this project was provided by The Robert Wood Johnson Foundation. The views presented in this report are those of the Institute of Medicine Committee on the Consequences of Uninsurance and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.