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February 15, 2002

Experts Highlight Perils of Nation's Uninsured

This week the Association of Academic Health Centers (AHC) refocused the nation's attention on the plight of the uninsured.

That's because, although academic medical centers make up only 6 percent of the nation's hospitals, they provide health care services to nearly half of the nation's uninsured patients. "It's a tremendous problem for us," said Dorothy Bainton, vice chancellor for academic affairs at UCSF.

Bainton's remarks launched the Feb. 4 symposium titled "Why Not Everyone? It's Time for Action on the Uninsured." The event was one of many held across the country prior to the Feb. 12 start of the national campaign. The UCSF symposium was held in the School of Nursing auditorium and was hosted by AHC, the UCSF Center for Health and Community and Philip R. Lee Institute for Health Policy Studies.

In all, eight faculty members presented their research. They illustrated the scope of the problem, reviewed the solutions being considered and described non-financial barriers faced by the uninsured.

More than seven million Californians are without health insurance. Nationwide, an estimated 42 million people are uninsured. "We're the only industrialized country without universal or near-universal health coverage," said Hal Luft, director of the Philip R. Lee Institute for Health Policy Studies and a professor of health policy and health economics.

The hospitals associated with UCSF directly provide care for people without health insurance. In addition, Luft added, UCSF is a major research site looking at why people don't have coverage and the implications for the uninsured themselves, the health care system and society as a whole.

Several of the speakers highlighted the non-random nature of the demographics of the uninsured. Thanks to recent efforts, a large percentage of children are insured, reported Paul Newacheck, professor of health policy and pediatrics and co-director of the MCH Policy Research Center located here and in Washington, DC. Despite the seemingly encouraging percentage, the fact is that 10 million nationwide are uninsured. Most uninsured kids, however, are eligible for health coverage under existing programs, but this requires patents to enroll them. "Many families don't think their children are eligible or they are unaware of the programs."

The situation is even more striking when it comes to dental care, said Jane Weintraub, director of the Center to Address Disparities in Children's Oral Health. An astonishing 23 million children nationwide do not have dental coverage, said Weintraub, also professor and chair of the division of oral epidemiology and dental public health in the school of dentistry. "Only 36 percent of the children living below the poverty line have visited the dentist in the previous year."

Likewise, the poor and members of racial and ethnic minority groups are more likely to be uninsured. Employment has a lot to do with whether or not a person has health coverage. And, those who work in the service industries or for small businesses are less likely to be covered. In San Francisco, coverage of children isn't the big issue, said Andrew Bindman, chief of the division of general internal medicine at San Francisco General Hospital Medical Center. "San Francisco County has the highest rate of uninsured adults in the state at 34 percent."

Several researchers are looking at whether health coverage can indeed erase the health disparities seen in this country based on race, ethnicity and socioeconomic status. "Insurance may not address cultural beliefs, language and communication barriers and environmental effects," said Jennifer Haas, associate professor of medicine. Giving a person insurance coverage will not remedy the years that person went without comprehensive and preventive health care, Haas added.

Bindman and others agreed that the problem of the uninsured is likely to worsen in the coming years. "As our economy declines, the number of uninsured will continue to grow." A lack of coverage leads to a decline in the use of medical services, Bindman explained. And that leads to an increase in the prevalence of otherwise preventable diseases, the presentation of diseases at later, less treatable stages and a general decline in other indicators of public health. "There are real health consequences of not having health care coverage. Anyone who doesn't think so isn't looking closely enough at the data."


Camille Mojica Rey


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