Massachusetts Health Insurance Plan
SOWK 500-3 Social Work Policy
Tracey Brenner, Karin Camera, Kelly Coffey, Anibal DaSilva, Timothy Fontana
Nancy Holland, Amanda Phillips, Patricia Wills, Henry Vandenburgh
Historical Background of the Policy
What historical problems led to the creation of the policy?
According to the Institute of Medicine of the National Academy of Sciences, the U.S. is the only wealthy, industrialized nation that does not have a universal health care system. In the United States, around 84% of citizens have some form of health insurance; either through their employer (60%), purchased individually (9%), or provided by government programs (27%) (There is some overlap in these figures). U.S. government programs accounted for over 45% of health care expenditures, making the U.S. government the largest insurer in the nation. Per capita spending on health care by the U.S. government placed it among the top ten highest spenders among United Nations member countries in 2004.
Americans without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people. Health insurance costs are rising faster than wages or inflation, and "medical causes" were cited by about half of bankruptcy filers in the United States in 2001.
United States health care is provided by a diverse array of individuals and legal entities. Individuals are offered inpatient and ambulatory outpatient services by commercial, charitable, or governmental entities. The healthcare system is not fully-publicly funded but is a mix of public and private funding. In 2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket 15%, federal government 34%, state and local governments 11%, and other private funds 4%.
("Ambulatory care" refers to health care delivered without a stay in the hospital; most health care in the United States occurs in the outpatient setting. "Home health care services" are generally nursing enterprises, but are usually ordered by physicians. Private sector outpatient medical care is provided by personal primary care physicians (specialists in internal medicine, family medicine, and pediatric medicine), subspecialty physicians (gastroenterologists, cardiologists, or pediatric endocrinologists are examples) or non-physicians (including nurse practitioners and physician assistants). In 1996, concierge medicine emerged, where enhanced care and services are provided by primary care physicians for a retainer fee.)
How important have these problems been historically?
Before the advent of technology in medicine, problems from inequality of coverage were more minimal. Patients were not able to access sophisticated care because it was not available. Charity care was written off by hospitals and frequently also by physicians. Large scale health insurance provision was generally not needed or available until after World War II, when technological advances and a desire to improve the working conditions of the American labor force ushered in health insurance for a majority of citizens and their families.
How were the problems previously handled in Massachusetts?
By mid-2006, there were about 372,000 Massachusetts residents uninsured of about 6,500,000 residents. Because medical bills are usually beyond the means of the poor, uninsured patients were forced to fall back