A survey has found that one of every eight US adults is “underinsured,” causing many families to file for bankruptcy and forgo needed health care (Health Affairs 2008 Jun 10; doi: 10.1377/hlthaff.27.4.w298).
The survey of 2616 US adults, conducted by the Commonwealth Fund, a charitable organisation based in New York that promotes a “high performing healthcare system,” found that 42% of people aged 19 to 65 had either no health insurance or were underinsured in 2007—up from 35% in 2003 (Health Affairs 2005 Jun 14; doi: 10.1377/hlthaff.w5.289).
Respondents were defined as underinsured if they spent 10% or more of their income on out of pocket medical expenses (5% if they were poor) or if the deductible (the portion they have to pay before insurance starts) is 5% or more of their income.
The Commonwealth Fund’s report found that 68% of uninsured people went without needed health care, such as forgoing recommended specialist appointments or failing to collect prescriptions for chronic diseases such as diabetes and asthma, and 53% of underinsured people and 31% of those in the category designated “insured, not underinsured” did the same. Fifty one per cent of uninsured people experienced a “medical bill problem or outstanding debt” compared with 45% of underinsured people and 21% of insured and not underinsured people.
The rise in underinsured families in the United States is, in part, the result of families facing ever higher deductibles because employers have struggled to cope with rising healthcare costs, said one of the study’s author, Sara Collins. Even after insurance does start, patients may have to pay 20% of their medical expenses.
Michael Millenson, visiting scholar at the Kellogg School of Management at Northwestern University in Evanston, Illinois, says that the plans are driving a substantial portion of bad medical debts.
The rise in the number of people either uninsured or underinsured has led to a flurry of policy recommendations. “It used to be that the US and South Africa were the only industrialised nations without universal healthcare—but it’s been a while since Nelson Mandela took over so now it’s only us,” said Mr Millenson. But, a single payer system, such as Canada’s, “won’t work,” he said. “We need a uniquely American solution.”
Dr Collins says that US presidential candidate Barack Obama is “recommending a minimum benefit plan similar to an existing, comprehensive plan covering federal employees and members of the US Congress.” John McCain, his opponent, she said, “has not talked about a standard package.”
Steffie Woolhandler is associate professor of medicine at Harvard and author of a study that found about half of all personal bankruptcies were the result, at least in part, of medical illness or medical bills. She told the BMJ that only a national health plan with a single payer can remedy the problem because even the best insurance is no protection for people who lose their jobs. “When you’re sick and can’t work, you lose your health insurance.” That, she said, “caused a lot of bankruptcies” (Health Affairs 2005 Feb 2; doi: 10.1377/hlthaff.w5.63).