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Caring for the Uninsured and Underinsured |

An American Approach to Health System Reform FREE

John Holahan, PhD; Marilyn Moon, PhD; W. Pete Welch, PhD; Stephen Zuckerman, PhD
[+] Author Affiliations

Reprint requests to Director, Health Policy Center, The Urban Institute, 2100 M St NW, Washington, DC 20037 (Dr Holahan).


From The Urban Institute, Washington, DC.


JAMA. 1991;265(19):2537-2540. doi:10.1001/jama.1991.03460190115031
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THE MAJOR problems in the United States' health care system today are the large number of uninsured Americans, the high and rising costs of the system, and the system's administrative complexity. With over 32 million Americans lacking health insurance at any time and 63 million Americans lacking health insurance at some point during a recent 28-month period, the problem of being uninsured is faced by a large percentage of the population.1-5 Despite this lack of coverage, the United States spends more on health care, per capita and as a percentage of gross national product (GNP), than any other country. In addition, we also have one of the highest rates of increase—over 4% per year after adjusting for inflation.6,7 Finally, it is estimated that the annual administrative expenses borne by insurance companies, physicians, hospitals, and other providers are about $80 billion, or 1.5% of GNP.8 This does not

REFERENCES

Monheit A, Short P.  Mandatory health coverage . Health Aff. Winter 1989;;8:22-39.
Moyer E.  A revised look at the number of uninsured Americans . Health Aff . (Summer) 1989;;8:102-110.
Swartz K. The Medically Uninsured: Special Focus on Workers . Washington, DC: The Urban Institute; July 1989;.
Zedlweski SR. Expanding the Employer-Provided Health Insurance System: Effects on Workers and Their Employers . Washington, DC: The Urban Institute. In press.
Nelson C, Short K. Health Insurance Coverage 1986-1988 . Washington, DC: Bureau of the Census, US Dept of Commerce; March 1990;. Current Population Reports, Household Economic Studies, Series P-70, No. (17) .
Schieler GJ, Poulier J-P.  International comparisons of health care expenditures . Health Care Financ Rev. 1989; Annual (Supplement) :1-8.
Poulier J-P.  Health care expenditure and other data . Health Care Financ Rev . (Summer) 1990;; 11:159-167.
Himmelstein DU, Woolhandler S.  Cost without benefit: administrative waste in U.S. health care . N Engl J Med. 1986;;314:441-445.
Himmelstein DU, Woolhandler S.  A national health program for the United States . N Engl J Med. 1989;;320:102-108.
The Pepper Commission (US Bipartisan Commission on Comprehensive Health Care). A Call for Action: Final Report. Washington, DC: US Government Printing Office; September 1990.
Balancing Access, Costs, and Politics: The American Context for Health System Reform . Washington, DC: The Urban Institute. In press. Urban Institute report 91-6.
Evans RG, Lomas J, Barer ML, et al.  Controlling health expenditures—the Canadian reality . N Engl J Med. 1989;;320:571-577.
Enthoven A, Kronick R.  A consumer choice health plan for the 1990s . N Engl J Med. 1989;;320:29-37,94-101.

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Monheit A, Short P.  Mandatory health coverage . Health Aff. Winter 1989;;8:22-39.
Moyer E.  A revised look at the number of uninsured Americans . Health Aff . (Summer) 1989;;8:102-110.
Swartz K. The Medically Uninsured: Special Focus on Workers . Washington, DC: The Urban Institute; July 1989;.
Zedlweski SR. Expanding the Employer-Provided Health Insurance System: Effects on Workers and Their Employers . Washington, DC: The Urban Institute. In press.
Nelson C, Short K. Health Insurance Coverage 1986-1988 . Washington, DC: Bureau of the Census, US Dept of Commerce; March 1990;. Current Population Reports, Household Economic Studies, Series P-70, No. (17) .
Schieler GJ, Poulier J-P.  International comparisons of health care expenditures . Health Care Financ Rev. 1989; Annual (Supplement) :1-8.
Poulier J-P.  Health care expenditure and other data . Health Care Financ Rev . (Summer) 1990;; 11:159-167.
Himmelstein DU, Woolhandler S.  Cost without benefit: administrative waste in U.S. health care . N Engl J Med. 1986;;314:441-445.
Himmelstein DU, Woolhandler S.  A national health program for the United States . N Engl J Med. 1989;;320:102-108.
The Pepper Commission (US Bipartisan Commission on Comprehensive Health Care). A Call for Action: Final Report. Washington, DC: US Government Printing Office; September 1990.
Balancing Access, Costs, and Politics: The American Context for Health System Reform . Washington, DC: The Urban Institute. In press. Urban Institute report 91-6.
Evans RG, Lomas J, Barer ML, et al.  Controlling health expenditures—the Canadian reality . N Engl J Med. 1989;;320:571-577.
Enthoven A, Kronick R.  A consumer choice health plan for the 1990s . N Engl J Med. 1989;;320:29-37,94-101.
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