Context: There is considerable research on the problems facing low-income, uninsured adults. Less is known about the extent that the uninsured use subsidized insurance when provided, or the impact of these benefits on their health.
Setting: The state of Vermont; a national leader in incremental health reform, with 14 rural and semi-urban counties, a population of 580,000, and an uninsured rate of 7% in 1997.
Results: VHAP improves access and promotes timely treatment in appropriate settings. Two thirds of eligible Vermonters enroll. Enrollees are sicker than non-enrollees, and male enrollees are unhealthier than females. Four in ten have a health problem and half have been uninsured for more than five years. A third have coverage at work, but opt for public insurance. While uninsured, half delay getting the care they need and a third go without it. In the year prior to enrollment, four in five visited a physician and one in five was hospitalized. After a year hospital use declined by 42%, ER use dropped 25%, and dental use increased by 10%. Doctor’s visits increased slightly and mental health visits increased by 97%. Insurance improved overall satisfaction and health status; the odds of reporting a health problem declined by 44%. The costs of VHAP are estimated to be lower than the costs of treating the uninsured. Program impact varies by age, gender, community and health status. A third lose eligibility within a year due to increased earnings.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Understand the benefits and costs of insuring low-income rural Amercians 2. Estimate the benefit use and resulting changes in health access, utilization, health status and satisfaction with health services 3. Generate hypotheses for future research on incremental health reform in the United States 4. Make recomemndations for expanding medical care access in rural America
Keywords: Access to Health Care, Insurance-Related Barriers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.