BMJ  2007;334:346-348 (17 February), doi:10.1136/bmj.39091.493588.BE

Analysis

Uninsured in America: problems and possible solutions

Commonwealth Fund, 1 East 75th Street, New York, NY 10021

Failure to ensure access to health care for all lies at the heart of the US failure to achieve value for money, says Karen Davis

The first 150 words of the full text of this article appear below.

The United States is the only major industrialised nation without universal health insurance, and coverage has deteriorated in the past six years. The consequences are increasingly well known: inequities in access to care, avoidable mortality and poor quality care, financial burdens on people who are uninsured or underinsured, and lost economic productivity. The US spends twice as much on health care as the median industrialised nation but does not systematically achieve the best quality care (table). What are the prospects for reform?

View this table:   Healthcare indicators for eight countries

 

Trends in uninsured and underinsured

The US has a mixed public-private system of health insurance. It comprises:

• Federal Medicare programme, covering people aged 65 and over and those who have been disabled for two years or more (12% of population)
  
• State Medicaid programmes—covering children from low income families and in some states their parents as well as providing long term care and cost sharing for acute care . . . [Full text of this article]

Access, quality, and equity implications

Prospects for action

State initiatives

Key to success

Suggested government actions to achieve universal health cover
Federal
States
Summary points

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