Lack of health insurance costs up to $130bn in illness and premature death

About 41 million US residents lack health insurance, and a new report estimates that this lack costs the nation and the people themselves between $65bn (£40bn; €56bn) and $130bn a year. "The society-wide costs of the 41 million uninsured are not primarily due to the expense of providing health services to those without coverage. Most of the cost of uninsurance reflects the poorer health and shorter lives of uninsured individuals, who frequently receive too little health care and receive it too late," said Dr Mary Sue Coleman, co-chair of the US Institute of Medicine committee that wrote the report. The report identifies—and, where possible, quantifies—the losses and inefficiency that stem from having 41 million Americans without health insurance. To estimate the costs the committee used the concept of health capital. "It is based on the value of a statistical year of healthy life," said James Mongan, a member of the committee. "This includes the cost of lost productivity along with the value that individuals place on being alive and healthy. We then estimated the economic cost of the premature deaths and higher burden of illnesses that exist among the uninsured, and we arrived at this range of $65bn to $130bn." The approach is similar to that widely used by other agencies to determine whether the benefits of reducing a particular risk or harm justify the costs involved, said Dr Coleman. "As policy makers weigh the cost and benefits of expanding coverage to the uninsured they should factor in the estimated $65 billion to $130 billion value of improved health that could be realised each year through continuous coverage," she said. In the past, said Mr Mongan, the debate on health care has focused on the financing, not on the health consequences. "I think these studies have laid important groundwork to making it clear that there are health consequences of being uninsured. It has been easy for people to assume that if they need care all they need to do is go to the hospital emergency room. This may be true for emergencies but not for many common illnesses and conditions." He described the report as taking important steps in documenting the consequences and laying out the monetary costs involved. The institute's report is the fifth on health care of uninsured people in the United States sponsored by the Robert Wood Johnson Foundation and is intended to lay the groundwork for a national debate on the issue during next year's US presidential election. The sixth and final report is likely to appear next January, said Dr Coleman. The report, Hidden Costs, Value Lost: Uninsurance in America , is available at www.nap.edu