> David Forslund wrote:
> > Tim Churches wrote:
> > > Despite having one of the highest per-capita spends on healthcare in the
> > > world, the US ranks in the bottom half (and often right at the bottom)
> > > of all OECD countries on just about every health and health outcome
> > > measure, on a population basis. Sure, for wealthier people in the US who
> > > can afford good health insurance, health outcomes are excellent, but
> > > those people represent about 50% of the total population. The rest of
> > > the population have really very bad outcomes, so the overall results are
> > > remarkably poor given the overall expenditure. And even amongst the
> > > insured, the quality and nature of the care is very patchy, due to the
> > > incredibly fragmented nature of the US healthcare system.
> > Where do you get your numbers? The percentage that isn't covered is
> > much smaller, I believe, particularly since people who haven't applied
> > and thus don't show up on a list are, in fact, covered. The quality
> > of healthcare is patchy, but not necessarily based on income, but on
> > locality.
>
> The healthcare insurance coverage is a figure I recall from a CDC Health
> People report, probably 5 years old or so - but it is at work. I'll look
> it up on Monday. The population-based health outcomes are documented in
> many places - again I'll look for a summary in some OECD reports on Monday.
I had a quick look around and you are quite right - only about 15% of
the total US population are completely without health insurance,
according to figures quoted in this (excellent) paper:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010039
However, the aboveURLed paper also mentions the problem of
under-insurance and intermittent insurance in the US health system,
which is rather widespread, because a) the US health insurance system is
not nearly as tightly regulated as it is in many other countries, so
insurance companies get away with whatever they can and b) there is no
concept of mandatory "community rating" i.e. health insurance companies
are not forced to spread the financial risk across all their customers,
and so can charge differential premiums, making higher levels of cover
unaffordable for those who most need it, and c) as you mention,
insurance is employment-related, so many people end up without health
insurance during periods of unemployment. The 50% figure I mentioned may
have included some definition of under-insurance or intermittent
insurance as well as the chronically uninsured. Or I may just be wrong.
However, the conclusion is the same: the health outcomes of the
uninsured (and under-insured) drag the average health outcomes for the
whole US down, by a large amount.
Tim C
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