John Z Ayanian, MD

1
What safety net?

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

2
What safety net?
The uninsured

• 33 million uninsured in 1998
• 14 of people 18-64 were uninsured at the time of
  the call.
• 9.7 were uninsured for gt1 year.
• 4.3 were uninsured for lt1 year.

Ayanian JZ, et al. JAMA 2000284(16)2061-2069
3
What safety net?
Long-term uninsured

• 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

4
What safety net?
Chronic diseases

• Patients without a checkup in the last 2 years
• Uninsured gt 1 year 42.8
• Uninsured lt 1 year 22.3
• Insured 17.8

5
What safety net?
Holes in the net?

• Options vary widely from state to state, region
  to region.
• Emergency rooms are treatment centers of last
  resort but arent well equipped to manage
  chronic diseases.

6
What safety net?
Through the cracks

• Most uninsured Americans work, but their wages
  are too low to get insurance.
• We need to offset cost for individuals and for
  small businesses.

7
What safety net?
The European model

• 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.

8
What safety net?
Solutions

• 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.

9
What safety net?
Regional differences

• Census region Uninsured
• Northeast 11.4
• South 16.9
• Midwest 9.8
• West 16.0

10
What safety net?
The study

• Unmet Health Needs of Uninsured Adults in the
  United States
• Ayanian JZ, et al. JAMA 2000284(16)2061-2069
• http//jama.ama-assn.org/issues/v284n16/toc.html