The Care of the Uninsured in America

As Dr. Cullen’s chapter on information technology points out, what is required is not just a new electronic system that follows the patients, but a new language that creates and defines a system that can appropriately care for the patient. What we design for the complexities of caring for the medically underserved can serve as model for caring for everyone in this country. Many innovative, bold, and wonderful solutions have been developed as local/ regional models. As communities and states we can learn from, and support, each other. But the local models are not, by and large, self-sustaining. Ultimately, so- tions to the lack of medical insurance in this country will require a national persp- tive, and federal funding. That is part of the work we all must do, and Dr. Dalen’s chapter points out some of the possibilities and pitfalls other countries have experienced. When I wonder how the system we have hasn’t already collapsed from its own weight, I just need to look at the people working within it. Healthcare is a service industry, and we have been blessed with professionals who understand and live the concept of service in their daily lives, who go the extra mile for the patient despite the vagaries, the barriers, and the sometimes mean spiritedness of the organi- tional infrastructure. The Care of the Uninsured in America Edited by Nancy J. Johnson, El Rio Community Health Center, Tuscon, AZ Lane P. Johnson, Arizona Health Science Center, Tucson, AZ They earn too much for Medicaid but not enough to afford a health plan. Or their employer rescinded their benefits. Or they’re "not disabled enough" for disability. Some 45 million people have fallen through the cracks of America’s health care system, and this lack of coverage affects access to coverage, timeliness of care—even life expectancy. __The Care of the Uninsured in America__ presents a nuanced portrait of this broad population—urban and rural, from generational poverty and the working poor—while illuminating the current state of medical/dental insurance and the circumstances that cause so many to do without. Its authors conceptualize lack of insurance as a health disparity (as are ethnicity, gender, age, etc.), and explain its collective health impact and major issues involved in providing care. In clear, useful prose, the book: * Identifies subpopulations among the uninsured (e.g., the mentally ill, the homeless, people with HIV) and their specific care needs. * Outlines necessary skills and strategies for working with uninsured patients, from health promotion to cultural competency. * Offers models and case examples of innovative care programs. * Reports on methods for improving access and support, including coalition building and health information management. * Describes medication assistance programs: how they work and what they cost. * Discusses chronic care and disease management among the uninsured. * Analyzes the universal health care debate and makes recommendations. __The Care of the Uninsured in America__ will attract a wide audience among professionals and graduate students in public and community health and health policy; clinicians and nurses who treat the uninsured; administrators and managers seeking a deeper understanding of the system; and policymakers and analysts seeking avenues for change. The Care of the Uninsured in America Edited by Nancy J. Johnson, El Rio Community Health Center, Tucson, AZ Lane P. Johnson, Arizona Health Science Center, Tucson, AZ They earn too much for Medicaid but not enough to afford a health plan. Or their employer rescinded their benefits. Or they're "not disabled enough" for disability. Some 45 million people have fallen through the cracks of America's health care system, and this lack of coverage affects access to coverage, timeliness of care--even life expectancy. The Care of the Uninsured in America presents a nuanced portrait of this broad population--urban and rural, from generational poverty and the working poor--while illuminating the current state of medical/dental insurance and the circumstances that cause so many to do without. Its authors conceptualize lack of insurance as a health disparity (as are ethnicity, gender, age, etc.), and explain its collective health impact and major issues involved in providing care. In clear, useful prose, the book: Identifies subpopulations among the uninsured (e.g., the mentally ill, the homeless, people with HIV) and their specific care needs. Outlines necessary skills and strategies for working with uninsured patients, from health promotion to cultural competency. Offers models and case examples of innovative care programs. Reports on methods for improving access and support, including coalition building and health information management. Describes medication assistance programs: how they work and what they cost. Discusses chronic care and disease management among the uninsured. Analyzes the universal health care debate and makes recommendations. The Care of the Uninsured in America will attract a wide audience among professionals and graduate students in public and community health and health policy; clinicians and nurses who treat the uninsured; administrators and managers seeking a deeper understanding of the system; and policymakers and analysts seeking avenues for change Front Matter....Pages i-xiv Who Are the Uninsured?....Pages 1-20 Why Are People Uninsured?....Pages 21-33 The Culture of Poverty and the Uninsured....Pages 35-44 Health Disparities and the Uninsured....Pages 45-61 Providers of Care for the Uninsured....Pages 63-85 Chronic Disease and the Uninsured....Pages 87-108 Medical Homes ( preferably “Health Home” ) and the Uninsured....Pages 109-127 Medication Assistance for the Uninsured....Pages 129-144 Medically Uninsured Refugees and Immigrants....Pages 145-151 Medically Uninsured and the Homeless....Pages 153-160 Care of Underserved People with Mental Illness....Pages 161-170 Medically Uninsured Older Americans....Pages 171-186 Direct Caregivers Association: An Option for a Rapidly Growing Aging Population?....Pages 187-194 The Rural Uninsured....Pages 195-204 Dental Care for the Uninsured....Pages 205-215 Uninsured Children at School....Pages 217-230 Building Community Collaborations Around Care for the Uninsured....Pages 231-241 Information Technology and Medically Uninsured....Pages 243-257 The Role of Government in Providing Health Care to the Uninsured....Pages 259-270 Think Nationally, Act Locally....Pages 271-278 Back Matter....Pages 279-285