Insurance and the Uninsured
An increase in emergency department visits by the uninsured was not a significant cause of an overall rise in ED visits between 1996 and 2003, according to a study in the Annals of Emergency Medicine. The study found that the increase in ED visits can be attributed to higher ED utilization by higher-income people and by people whose usual source of care is a physician's office.
The researchers found that uninsured individuals accounted for 15.5% of ED visits in 1996-1997 and 14.5% of visits in 2003-2004. At the same time, the proportion of visits by higher-income people increased from 21.9% to 29%, and the proportion of those who typically obtain care in a physician's office rose from 52.4% to 59%.
The authors wrote that the findings have significant implications for current policy discussions because they suggest that providing health insurance alone will not address ED overcrowding, access to health care services and appropriateness of those services (Weber et. al, Annals of Emergency Medicine, April 2008).
The study is available online. (.pdf)
Relatively few uninsured households have sufficient financial assets to cover cost sharing in high-deductible health plans tied to health savings accounts, a study in Health Affairs found.
According to the study, in households with one uninsured member, less than half had sufficient gross financial assets to meet the minimum HSA-related deductibles, about one-third could meet the average deductible for non-group plans and less than one-fourth could meet the maximum out-of-pocket limit permitted by law. Households with more than one uninsured member were more likely than those with only one uninsured member to not have enough assets to meet cost-sharing requirements.
The authors wrote that while higher cost sharing reduces the cost of premiums, high-deductible health plans with HSAs might not provide adequate financial protection for lower-income families with high medical needs. Policymakers and others involved in improving coverage for the uninsured should consider other options beyond the current high-deductible model, such as options that take family financial circumstances into consideration (Jacobs/Claxton, Health Affairs, 4/15).