Number Of Uninsured Children Research Articles

The Role of Private Health Insurance in Children's Health Care

Private health insurance is the primary means of financing health care for America’s children and pregnant women. Most coverage is provided under employer plans. Access to private health care coverage, however, is threatened by the increasing cost of health care, cost shifting by providers, and insurance marketing practices that tend to deny coverage to high-risk individuals. These pressures have already led to an increase in the number of uninsured children and pregnant women. This paper provides an overview of the private health insurance market with a focus on recent trends. The effects of self-funding arrangements by employers and of various cost-control arrangements—including managed care plans, patient cost-sharing provisions, and employee premium contributions—are examined for their potential impact on children and pregnant women. Policies that might expand health insurance coverage for children, including a universal health insurance plan, and health insurance market reforms, are explored. Alternative strategies for enhancing universal health insurance coverage for children include mandatory employer-based insurance programs, a program of tax credits to underwrite individual insurance plans, and a single-payer government program financed through the tax system. The authors conclude that efforts should be made to preserve the current private health insurance system by reducing cost shifting from public programs, guaranteeing the availability of coverage to all groups, and controlling costs by means of competition, managed care, and perhaps global spending limits. Such comprehensive reforms might be necessary merely to preserve private insurance coverage for a majority of America’s children and pregnant women. P rivate insurance is the primary source of funding for health care for children and pregnant women in the United States. The March 1990 Current Population Survey (CPS) reports that about 63% of all children are covered as dependents under employer health insurance plans and another 10% are covered under individually purchased non-group insurance. About 60% of pregnant women are covered under employer plans, either as employees or as dependent spouses, and about 6% have non-group coverage. The extent of private insurance coverage for children declined during the 1980s largely because of an increase in health care costs, a John F. Sheils, M.P.P., is vice president of Lewin-ICF, a research

Caring for the Uninsured Choices for Reform

These recent events provide the impetus for this theme issue ofThe Journal: (1) Government reports show a 24% increase in the last decade in the total number of uninsured people and a 40% increase in the number of uninsured children.^1-4Most uninsured children are part of a family with a working adult. (2) Recent studies have found that, despite considerable amounts of uncompensated care provided by hospitals and physicians, Americans without health insurance face major barriers to the receipt of needed health services. Although they suffer from higher rates of ill health than the insured population, the uninsured report fewer hospitalizations and fewer visits to a physician, shorter hospital stays, and fewer discretionary inpatient hospital treatments and tests, at higher cost. The uninsured also experience higher mortality rates when hospitalized than persons with health insurance coverage who have similar medical diagnoses.^5-11(3) There is evidence of growing