(HealthDay is the new name for HealthScoutNews.)
TUESDAY, Aug. 12, 2003 (HealthDayNews) -- As the nation's presidential campaign looms closer, physicians are tackling anew the continuing health insurance crisis.
Two articles in the Aug. 13 issue of the Journal of the American Medical Association propose solutions to the problem.
After finding that uninsured adults were more likely to avail themselves of preventive health services after turning 65 and becoming eligible for Medicare, the authors of one study propose that this government health plan be extended to uninsured people at the age of 55. Medicare is currently available only to people over 65 or to certain younger people with disabilities.
"In this very vulnerable population, if we were to make that happen, we could expect these great benefits in their health care to occur," says study author Dr. J. Michael McWilliams, a medical resident at Brigham and Women's Hospital in Boston. "One argument against insuring uninsured populations is that uninsured people choose to be uninsured and don't value their health. But this shows that, in large part, when uninsured people are given insurance that they do indeed go out and get the services that they should get."
An estimated 41 million Americans lack health insurance, while another 58 million are without health insurance for at least part of the year. Meanwhile, the segment of the population aged 55 to 64 is expected to increase rapidly. By 2015, according to the study authors, this group will comprise almost 20 percent of the population.
"There is a growing body of evidence that says that people who are uninsured don't get care to the same degree that people who are insured do," says Dr. Stephen Schoenbaum, senior vice president of the Commonwealth Fund, which provided some of the funding for the study. "This paper contributes another piece of evidence."
McWilliams and his colleagues compared the use of various preventive services among 2,203 near-elderly (between 55 and 64 years old) before and after becoming eligible for Medicare. The participants were divided into three groups according to their insurance status before Medicare: continuously uninsured, intermittently uninsured and continuously insured.
Before being eligible for Medicare, 41 percent of uninsured adults received cholesterol testing, compared with 76 percent of insured adults. After Medicare, 65 percent of previously uninsured adults received cholesterol testing versus 83 percent of the previously insured group.
Prior to Medicare, 46 percent of uninsured women got mammographies versus 76 percent of insured women. After Medicare, 67 percent of previously uninsured women were screened, compared with 82 percent of previously insured women.
Before Medicare, only 29 percent of uninsured men were screened for prostate cancer, compared with 74 percent of insured men. After becoming eligible for Medicare, however, 67 percent of previously uninsured men got screened, compared with 81 percent of previously insured men.
Individuals with arthritis also reported more visits to physicians after enrolling with Medicare.
"Certainly the dramatic reduction in the gaps between insured and uninsured with respect to preventive services demonstrates that gaining health insurance alone does improve health care for previously uninsured adults," McWilliams says. "Also, among adults at higher risk of heart disease because they had high blood pressure or diabetes, the impact of Medicare on cholesterol testing was even greater, suggesting that older, uninsured Americans in greatest need of services may, in particular, benefit."
Economic considerations seem to be fueling individual health-care decisions at all levels. The authors also found Medicare coverage did not appear to have an effect on individuals' use of medications. "Presumably this is because Medicare lacks prescription drug coverage," McWilliams says.
The Physicians' Working Group for Single-Payer National Health Insurance authored another article in the same issue of JAMA, this one endorsing the creation of a national health insurance plan providing universal coverage in the United States. Again, this program would be modeled on Medicare and "would cover every American for all medically necessary services, including long-term care, mental health and dental services, and prescription drugs and supplies," the authors write.
Under the proposed program, patients would be able to choose their own physician and hospitals would receive a monthly lump sum to cover all operating expenses.
The authors envision a win-win-win situation. "Clinical decisions would be driven by science and compassion, not the patients' insurance status or bureaucratic dictum. National health insurance would offer physicians a choice of payment options and practice settings. Nurses and other personnel would also benefit from the reduction in paperwork and a more humane clinical milieu."
Whether any of these proposals actually make it off the drawing board is another question, but the timing may be critical. "The presidential campaigns are heating up and many of the presidential candidates have come out with plans for increasing coverage for the uninsured," says Schoenbaum. "This provides information to those who are interested in covering the uninsured about a group of people who are particularly in need of coverage, namely the near-elderly who aren't insured."