America's Uninsured Crisis

National Level

"In its 2009 report America's Uninsured Crisis: Consequences for Health and Health Care, the Institute of Medicine points to a chasm between the health care needs of people without health insurance and access to effective health care services. This gap results in needless illness, suffering, and even death."

- Institute of Medicine of the National Academies

Physician Volunteerism at the National Level

Community physicians donate significant amounts of pro-bono care. According to a 1998 study in JAMA*, patients without insurance were most likely to receive care at private physician offices:
  • 32.1% No usual source of care
  • 34.8% Private offices/HMO's
  • 14.8% Hospital-based clinics
  • 16.1% Clinic or health center
  • 20% Emergency departments
*Cunningham PJ. JAMA. 1998;280:921

Yet, physicians are less likely to provide pro-bono care today than they were 10 years ago. From 1997 to 2005 physicians providing charity care dropped from 76% to 68%.* The reasons are many, but include:
  • Increasing number of physicians are employees
  • Increasing pressures associated with lower physician payment plans
  • Increasing administrative burdens associated with multiple payers and managed care
* Milbank Quarterly March 2008 Vol. 86 Issue 1, 91-123 Care for the uninsured is particularly difficult, as it is difficult to access the required ancillary tests and procedures often required when providing comprehensive primary and specialty care. The reasons again are many but include:
  • Lack of local community support in caring for the uninsured
  • Burden associated with convincing others to provide pro-bono care rests with the treating physician
  • Hospitals are only obliged to provide emergency department and hospital-based care, thus increasing both patient and physician reliance on them as a safety net

New Haven's Uninsured

Number of Uninsured - Estimates from 2008

  • Estimated 19, 000 uninsured1 in New Haven (14.9%) and rising2*
  • Estimated number of uninsured at FQHC's3:
    • Hill Health Center: 5,115 (25%)
    • Fair Haven Health Center: 7,250 (45%)
1HRSA formula: 200% Federal Poverty Level - # Medicaid
3Personal comm., Katrina Clark (Fair Haven) Gary Spinner (Hill)
2Health Affairs 2009; 28(4): 573-77
*Excludes 10-15,000 undocumented immigrants, U.S. Census Report 2005

How Much Uncompensated Care Is Provided in New Haven FY08?

  • YNHH - $85.8 million
  • Hospital St. Raphael (HSR) - $24.8 million
  • Yale Medical Group (YMG) - $8 million
  • St. Raphael Faculty Physicians - $1.8 million
Personal communication, Simon Laganiere YMS, David Leffel YMG, James Staten YNHH; Stephanie Arlis-Mayor HSR; July 2009
Hospital of Saint Raphael Community Benefit Report FY2008

Local Options to Improve Medical Insurance Coverage

  • Role of CHCs, FQHCs
  • Role of hospital-based or county clinics
  • Role of free clinics
  • Better organized, coordinated volunteer physician component
  • Medical insurance for working poor

Links to other Project Access sites:

Project Access - Ashville, North Carolina
Project Access - Dallas, Texas
Project Access - Wichita, Kansas