Falling Through the Safety Net

An evaluation of the ways insurance status affects one's health and use of health services. The authors describe existing patterns of insurance coverage in the United States and examine the variations in utilization of health services and patient outcomes according to type (or lack) of insurance.

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As the national debate on health care reform intensifies, there is increasing interest in how insurance coverage affects the medical care people receive. In "Falling Through the Safety Net", Joel Weissman and Arnold Epstein, the latter a member of Hillary Rodham Clinton's health care task force, evaluate what is currently known about how insurance status affects one's health and use of health services. The authors begin by setting forth a conceptual framework for the study of access to health care. They describe existing patterns of insurance coverage in the United States and examine the variations in utilization of health services and patient outcomes according to type (or lack) of insurance. Among the topics discussed are frequency of physician visits, admission to hospitals and length of hospital stay, "patient dumping", preventive care, prescription drug use, avoidable hospitalizations, Medicaid and nursing homes. The source of medical payment, the authors argue, has a substantial effect of the amount, location and quality of care received in the US health system.
In a final section, the authors describe the history of attempts to develop national health insurance and provide a taxonomy of different sorts of insurance reform. They conclude by discussing criteria that can be used to determine the success of any reform package. This book should be of interest to professionals in health policy and management in both research and policy-making capacities.