Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

5
The Uninsured and Hospital Care in the Inner City: Patient Dumping, Emergency Care, and Public Policy

Mitchell F. Rice and Woodrow Jones


INTRODUCTION

According to the 1988 U.S. Bureau of Census Current Population Survey (CPS), 31 million Americans or some 15 percent of the population do not have some form of medical insurance or are not covered by Medicare or Medicaid. This figure, while an increase of 2 million since 1980, is less than the widely held figure of some 37 million (U.S. Congress, 1988). The considerably fewer number of uninsured individuals is due to two major reasons: (1) the health insurance questions on the CPS were asked of more adults and include more health insurance programs, and (2) additional questions were asked about coverage of children by Medicaid and private health insurance ( Moyer, 1989). About 25 million of these individuals are workers and their dependents ( Moyer, 1989). The firms that employ these individuals provide no health insurance or the employed has opted not to pay for health coverage. Further, one-fifth of the uninsured are children under the age of 15 (U.S. Congress, 1988).

The vast numbers of uninsured have generated much policy debate about the responsibilities of hospitals and medical centers in being responsive to the hospital and medical needs of uninsured patients. Many of the uninsured delay seeking medical care until their illnesses have become most severe. As a result, the cost of providing care increases because the severity of medical conditions being treated increases. Many hospitals are forced to stabilize these patients and attempt to transfer them to facilities that are willing to accept high-risk and high-cost patients who have limited insurance coverage

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