What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard...

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What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA

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Long-term uninsured What safety net? Uninsured by annual income: $0 - 15,000: 36.0% $15,000 – 24,999: 27.5% $25,000 – 34,999: 14.4% $35,000 – 49,999: 6.5% $50,000 – 74,999: 3.7% $75,000+: 2.4%

Transcript of What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard...

Page 1: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

What safety net?

John Z Ayanian, MDAssociate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA

Page 2: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

The uninsuredWhat safety net?

33 million uninsured in 1998

14% of people 18-64 were uninsured at the time of the call.

9.7% were uninsured for >1 year. 4.3% were uninsured for <1 year.

Ayanian JZ, et al. JAMA 2000;284(16):2061-2069

Page 3: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

Long-term uninsured What safety net?

Uninsured by annual income:

$0 - 15,000: 36.0% $15,000 – 24,999: 27.5%

$25,000 – 34,999: 14.4% $35,000 – 49,999: 6.5%$50,000 – 74,999: 3.7% $75,000+: 2.4%

Page 4: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

Chronic diseasesWhat safety net?

Patients without a checkup in the last 2 years

Uninsured > 1 year: 42.8%Uninsured < 1 year: 22.3%Insured: 17.8%

Page 5: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

Holes in the net?What safety net?

Options vary widely from state to state, region to region.

Emergency rooms are “treatment centers of last resort” but aren’t well equipped to manage chronic diseases.

Page 6: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

Through the cracksWhat safety net?

Most uninsured Americans work, but their wages are too low to get insurance.

We need to offset cost for individuals and for small businesses.

Page 7: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

The European modelWhat safety net?

In the US, the 80-85% with insurance have access to excellent basic care.

The 15-20% without do not have adequate access to care.

The rest of the western nations, almost all have at least access to adequate care.

Page 8: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

SolutionsWhat safety net?

Recognize the magnitude of the long-term problem.

Need bipartisan support and partnership.

State governments must be involved.

All Americans need access to a basic level of care.

Page 9: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

Regional differencesWhat safety net?

Census region % Uninsured

Northeast 11.4South 16.9Midwest 9.8West 16.0

Page 10: What safety net? John Z Ayanian, MD Associate Professor of Medicine and Health Care Policy Harvard Medical School Boston, MA.

The studyWhat safety net?

Unmet Health Needs of Uninsured Adults in the United States

Ayanian JZ, et al. JAMA 2000;284(16):2061-2069

http://jama.ama-assn.org/issues/v284n16/toc.html


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