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ACCESS
TO CARE Uninsured US Adults Have Unmet Health Needs Comprehensive Follow-up Care for High-Risk Infants Primary Care in the United States State Programs Provide Care in Underserved Areas Access to Substance Abuse Treatment After Capitation Invited
Commentaries   ACCESS
TO CARE Uninsured US Adults Have Unmet Health Needs Comprehensive Follow-up Care for High-Risk Infants Primary Care in the United States State Programs Provide Care in Underserved Areas Access to Substance Abuse Treatment After Capitation Invited
Commentaries ACCESS
TO CARE Uninsured US Adults Have Unmet Health Needs Comprehensive Follow-up Care for High-Risk Infants Primary Care in the United States State Programs Provide Care in Underserved Areas Access to Substance Abuse Treatment After Capitation Invited
Commentaries ACCESS
TO CARE Uninsured US Adults Have Unmet Health Needs Comprehensive Follow-up Care for High-Risk Infants Primary Care in the United States State Programs Provide Care in Underserved Areas Access to Substance Abuse Treatment After Capitation Invited
Commentaries |
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October 25, 2000 ACCESS TO CARE A JAMA THEME ISSUE Edited by Drummond Rennie, MD, and Richard M. Glass,
MD Prior studies have indicated that lack of health insurance is
associated with serious adverse clinical consequences, belying beliefs
that uninsured people are able to obtain care from safety-net providers.
In this analysis of data from national surveys in 1997 and 1998, Ayanian
and colleagues found that 14% of adults aged 18 to 64 years were uninsured
and 9.7% had been uninsured for 1 year or longer. Uninsured adults,
especially those in poor health, were 2 to 3 times more likely than
insured adults to report that they could not see a physician when needed
in the past year because of cost. Adults who had been uninsured for more
than 1 year were least likely to report having received a routine checkup
by a physician during the prior 2 years or appropriate preventive
services. Eisenberg and Power, in a special communication, emphasize that
health insurance alone does not guarantee high-quality care. In a
commentary, Grumbach argues for universal health care coverage in the
United States. Care of high-risk infants after nursery discharge is often fragmented
and typically does not include care for acute illnesses. Broyles and
colleagues assigned very-low-birth-weight infants born at a public
hospital to receive either routine care (well-baby care and care for
chronic conditions) or comprehensive care (routine care plus care for
acute illnesses). Between nursery discharge and 1-year adjusted age, the
total number of illnesses resulting in death or admission to a pediatric
intensive care unit was significantly less in the comprehensive-care group
than in the routine-care group. Clinic visits and telephone contacts with
clinic staff were more frequent in the comprehensive-care group; hospital
admissions were similar. Overall, the estimated mean cost per infant for
all care was $6265 for comprehensive care and $9913 for routine
care. In this analysis of data from national surveys on ambulatory care,
Forrest and Whelan found that the US population made 1.3 primary care
visits per person in 1994. Compared with white, non-Hispanic persons,
Hispanic persons made 20% fewer primary care visits per person, and black,
non-Hispanic persons made 33% fewer visits per person. Most primary care
visits occurred in private physicians' offices, even among ethnic
minorities and persons with no insurance or Medicaid. Rates of primary
care visits made to physicians' offices, however, were lower for ethnic
minorities than for white persons, whereas rates of primary care visits to
community health centers and hospital outpatient departments State initiatives to encourage health care practitioners to work in
underserved areas are less well known than similar federal programs, as
the National Health Service Corps. Pathman and colleagues identified 82
nonfederal programs in 41 states operating in 1996 that provided financial
support to physicians and nonphysician primary care practitioners in
exchange for service in underserved areas. The number of primary care
clinicians (1676) serving in these state programs was about equal to the
number serving in federal programs. Nevertheless, notes Lurie in a related
commentary, the state and federal workforces combined still fall far short
of the estimated need for clinicians in underserved
areas. In the early 1990s, as part of the Oregon Health Plan, Oregon more than
doubled its population of Medicaid-eligible persons and required Medicaid
recipients to enroll in a prepaid health plan. In May 1995, the Oregon
Health Plan implemented a capitated chemical dependency benefit,
integrating it with the primary care benefit. Deck and colleagues found
that after implementation of the capitated benefit, the percentage of
Medicaid-eligible persons admitted to substance abuse treatment programs
increased by about 40%. "In a world of externally managed medicine, making personal contact
with our patients never seemed more important. Isn't that why we became
physicians?" From "My Name Is Jack." An examination of the economic and workforce resources and policy
issues that shape health care for the rural elderly. The unmet needs of children and adolescents who require mental health
services are coming under increased scrutiny by federal health officials
and professional groups. US presidential candidates George W. Bush and Al Gore outline how each
would ensure access to health care for all Americans.
See and See Invited Commentary FULL TEXT | PDF See Invited Commentary FULL TEXT | PDF JAMA Patient Page For your patients: Information about premature
infants. |
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© 2000 American Medical Association. All rights reserved. |
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