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Addressing the Needs of the Uninsured in a Challenging Economic Environment

Samuel Zuvekas, Ph.D.


On March 12, 2002, Samuel Zuvekas, Ph.D., made a presentation in a Web-assisted teleconference at Session 1, which was entitled "Trends in the Uninsured: Impact and Implications of the Current Economic Environment."

This is the text version of Dr. Zuvekas's slide presentation. Select to access the PowerPoint® slides (160 KB).


Trends in the Uninsured: Impact and Implications of the Current Economic Environment

Samuel Zuvekas, Ph.D.
Senior Economist
Agency for Healthcare Research and Quality

Slide 1

Implications of Being Uninsured

  • Access to care.
  • Health outcomes.
  • Financial impact for families and individuals.
  • Burden on the delivery system.

Slide 2

Access Problems

  • No regular or usual source of care.
  • Difficulties and delays in getting care.
  • Health care use.

Slide 3

Percent of under 65 Population with No Usual Source of Care

This slide shows a bar graph of the percent of under 65 population with no usual source of care by coverage. Approximately 40 percent of the uninsured have no usual source of care, 11 percent of those covered by public programs, and 12 percent of those with private coverage have no usual source of care.

Source: Weinick, Zuvekas & Drilea, MEPS Research Findings, No. 3

Slide 4

Percent of Families Experiencing Difficulties, Delays, or Unmet Need

This slide shows a bar graph of the percent of families experiencing difficulties, delays or unmet need. Approximately 25 percent of families where all members are uninsured experienced difficulties, delays or unmet need. Approximately 20 percent of families where some members are uninsured experienced difficulties, approximately 12 percent of families in public programs, and approximately 6 percent of families with private programs experienced difficulties, delays or unmet needs.

Source: Weinick, Zuvekas & Drilea, MEPS Research Findings, No. 3

Slide 5

Health Outcomes

  • Preventive care.
  • Care for chronic conditions (e.g. diabetes, hypertension, HIV/AIDS).
  • Process vs. Outcomes.
  • Institute of Medicine (IOM) Report.

Slide 6

Preventive Care Services

This slide shows a bar graph of the percent of individuals who utilize preventive care services. Approximately 50 percent of the uninsured and 75 percent of those with private coverage had their blood pressure checked. Approximately 70 percent of uninsured women between 50 and 64 and 85 percent of those with private coverage had a mammogram. And approximately 35 percent of uninsured women and 60 percent of women with private coverage between the ages of 17 and 64 had a pap smear within the last year.

Source: Taylor, Cohen, & Machlin (2001)

Slide 7

Financial Impact

  • Pay out of pocket, no insurance discounts.
  • Financial burden relative to income.
  • Catastrophic illnesses.

Slide No. 8

Percent of Families with High Out of Pocket Burden*

This slide shows a bar graph of the health status of family head by health condition and coverage level. 12 percent of family heads with fair-poor health status are uninsured and 3 percent have private coverage. 5 percent of family heads with good-excellent health are uninsured and 1 percent have private coverage.

*Greater than 20 percent of family income.

Source: Taylor, Cohen, & Machlin (2001)

Slide No. 9

Burden on the Delivery System

  • Charitable care.
  • Public financing.
  • Cost-shifting.
  • Inefficient use.

Slide No. 10

Percent of under 65 Population with No Usual Source of Care

This slide shows a bar graph of the percent of under 65 population with no usual source of care over time. In 1977, approximately 25 percent of the uninsured had no usual source of care, compared with 15 percent of those in public programs and 13 percent of those with private coverage. In 1987, approximately 32 percent of the uninsured had no usual source of care compared with 13 percent of those in public programs and 17 percent of those with private insurance coverage. In 1996, approximately 38 percent of the uninsured had no usual source of care compared with 12 percent of the uninsured and 13 percent of those with private coverage.

Source: Zuvekas and Weinick (1999)

Slide No. 11

Percent of Children Under 18 with No Usual Source of Care

This slide shows a bar graph of percent of children under 18 with no usual source of care by age and coverage source. Among children ages 0 to 4, approximately 17 percent of the uninsured, 7 percent in public programs and 3 percent with private coverage have no usual source of care. Among children ages 5 to 9, approximately 17 percent of the uninsured, 12 percent in public programs and 5 percent with private coverage have no usual source of care. Among children ages 10 to 14, approximately 20 percent of the uninsured, 11 percent in public programs and 6 percent with private coverage have no usual source of care. And among children ages 15 to 17, approximately 27 percent of the uninsured, 20 percent in public programs and 10 percent with private coverage have no usual source of care.

Source: McCormick, et al (2000)

Slide No. 12

Access Problems of the Insured

  • Incomplete coverage.
  • Non-financial barriers.
  • Disparities.

Slide No. 13

Effects of Health Insurance and Income on Health Disparities

This slide shows a bar graph of the percentage point disparity of ethnic groups by income, health insurance and usual source of care.

Source: Weinick, Zuvekas, & Cohen (2000)

Slide No. 14

Health Care Spending in the under 65 Population, 1996

This slide shows a bar graph of health care spending in dollars of the under 65 population in 1996 by total per capita and out of pocket spending. Total per capita spending is approximately $900 for the uninsured, $2300 for those in public programs, and $1900 for those with private coverage. Out-of-pocket spending is approximately $400 for the uninsured, $200 for those in public programs, and $300 for those with private coverage.

Source: Cohen, Machlin, Zuvekas, et al., MEPS Research Findings, No. 12

Slide No. 15

Health Care Spending for Children Aged 17 and Younger, 1996

This slide shows a bar graph of total per capita and out-of-pocket health care spending for children aged 17 and younger in 1996. Total per capita spending is approximately $350 for the uninsured, $1000 for those in public programs and $1100 for those with private coverage. Out-of-pocket spending is approximately $200 for the uninsured, less than $50 for those in public programs, and over $200 for those with private coverage.

Source: McCormick, et al. (2001)

Current as of June 2002


Internet Citation

Trends in the Uninsured: Impact and Implications of the Current Economic Environment. Slide Presentation by Samuel Zuvekas at Web-Assisted Teleconference, "Addressing the Needs of the Uninsured in a Challenging Economic Environment." Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/uninsurteleconf/session1/zuvekastxt.htm


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