Sicker and Poorer

In the opening article of this special supplemental issue, Jack Hadley presents a detailed review of 25 years of research literature on the impact of health insurance on health and access to care. Using a model of the determinants of health to organize and interpret empirical findings, Hadley finds corroborating evidence that the uninsured receive fewer preventive and diagnostic services, tend to be more severely ill when diagnosed, and receive less therapeutic care as compared to the uninsured. Hadley reports a 4 to 25 percent reduction in the uninsured’s mortality, if they were otherwise insured. Additionally, his review notes that improving health status from fair or poor to very good or excellent would increase both work effort and annual earnings by as much as 20 percent. (Medical Care Research and Review 60(2)(supplement): 3S–75S, June 2003.)

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