FMHC - Uninsured/Underinsured
what insurance type leads to the most underinsured patients?
individual coverage
What are the two primary reasons why people do not have health insurance in the U.S?
1. cost/plan is too high 2. Lost job or changed employers
What options does a patient have if they are underinsured and cannot afford a needed medical procedure?
1. have the procedure and make financial adjustments elsewhere (ex: food, rent, utilities, car, etc) 2. delay procedure (pt lives w/ unnecessary pain or illness; disease proliferates, missing work, death) 3. have procedure and not pay medical bills (debt) 4. payment plans (carecredit, etc)
Demographic characteristics of Americans who are uninsured
Family work status: 1 or more full-time workers Ages: 26-54 the amount of uninsured is much higher than the total population Occupations: construction workers, cooks, drivers Race: 41% white, 37% Hispanic, 14% black
How many Americans have no health insurance?
In 2015....9% are uninsured or 29 million
what are the average monthly premiums for health insurance plans on marketplace?
Individual plan in 2018: 5,280 $/year Family plan in 2018: $14,016 /year
What is the difference between uninsured and underinsured?
Uninsured: no health insurance coverage at all Underinsured: high health plan deductibles and out-of-pocket medical expenses relative to income
You are considered underinsured if...
out-of-pocket costs equal to greater than or equal to 10% of household income out-of-pocket costs equal to >= 5% of household income if income is under 200% FPL Deductible is greater than 5% of household income
What are the financial consequences of being uninsured or underinsured?
lingering financial problems because of medical bills ex: received a lower credit rating, used all of savings, took on credit card debt, took out a mortgage against home/loan, had to declare bankruptcy
What is the main cause of personal bankruptcy?
medical issues
what is the economic burden of being uninsured?
no preventative care, wait until symptoms of disease or injury become too much to bear, seek treatment in ED for all ailments, if patient cannot pay, hospital absorbs the cost of treatment
What are the health consequences of being uninsured or underinsured?
pushing off medical needs because of cost, therefore, delayed healing. ex: has a medical problem, but does not go to doctor does not fill a prescription, skipped a medical test, treatment, or follow-up recommended by a doctor, did not see a specialist when referred.
How is uncompensated care paid for in the U.S?
under EMTALA, a patient has to be seen regardless of ability to pay, so the hospitals alone have expenditures of $38.3 B annually. Federal DSH Payment (60-65%) to state and local government to philanthropic donations