Health, Health Insurance, and the Uninsured

Abstract

THE PURPOSE of this article is to express a personal viewpoint that might be useful in designing policies to improve the health of the American population. Emphasis will be placed on the uninsured. The viewpoint is based on my experience and research findings from a series of studies that had the following objectives: (1) to improve measures of quality and health status^1-4; (2) to determine how a person's health status or quality was altered by economic incentives or disincentives such as the lack of any health insurance, the level of out-of-pocket payment in the fee-for-service system, or membership in a capitated health maintenance organization plan as opposed to the fee-for-service system^5-19; (3) to develop explicit measures of medical appropriateness and to use those measures to determine how much care may not be necessary^20-27; (4) to study how physicians' behavior was affected by both economic incentives and the