Information and Resources

Panel: Health Picture Poor for Uninsured

Feb. 24, 2009 -- The Institute of Medicine (IOM) says its latest report shows overwhelming evidence that a lack of health insurance has direct health effects on children and adults.

The group also warns that widespread lack of insurance may even have a negative effect on the access to health care of fully-insured people.

The IOM report calls on Congress and the president to act "on an urgent basis to achieve insurance coverage for everyone." It also urges policy makers to find ways to control health costs for the long term.

"We believe that the decline in health insurance coverage will continue, and we see no evidence of any forces that are likely to reverse it" unless policy makers reform the system, says Larry Lewin, founder of the Lewin Group health consulting firm and chairman of the IOM panel that wrote the report.

The report does not make suggestions on how to control costs and experts declined at a news conference to recommend how to achieve universal health coverage or how much to spend to get it.

But it lays out broad evidence that people without insurance suffer worse health outcomes and tend to die more quickly than similar people with coverage. For example, uninsured adults with heart failure or who suffer a heart attack are more likely to die than comparable patients with coverage, the report states. Uninsured children are less likely to visit a doctor or get immunizations, it adds.

"I think it puts to rest this issue of, 'is insurance important or is it not important.' I think this report allows us to get beyond that conversation," says Christine Ferguson, a member of the IOM panel and a research professor at the George Washington University School of Public Health and Health Services.

Researchers have known for years that uninsured patients face poorer prospects than insured patients once they are sick. But the report also warns that the rising number of uninsured -- now estimated at nearly 46 million -- could be dragging down the quality of care for insured people as well. 

Hospitals, doctors, diagnostic clinics, and other health providers tend to focus their attention on "well-capitalized" areas, the report says. As the number of uninsured rise, providers may take flight, leaving insured and uninsured alike without easy access to services.

Experts pointed to cities like Denver, where a major university hospital closed its doors downtown and moved to a new campus in the suburbs.

"It's a way that we share this problem across the uninsured and insured members of the community," said John Z. Ayanian, a professor of Medicine and Health Care Policy at Harvard Medical School and a panel member.