US Uninsured Rate at 14%, but Bush Administration Prepares for Many to Lose Insurance
The robust US economy in the year 2000 combined with a boost in government programs to cover children and the indigent dropped the numbers of uninsured Americans to 14%, or 38.7 million, compared with 14.3%, or 39.3 million, in 1999, according to figures released by the US Census Bureau. However, the current economic problems demonstrated by the crisis on Wall Street and exacerbated by the woes that followed the tragedies at the World Trade Center and the Pentagon promise to increase the uninsured rolls to new highs in the years 2001 and 2002.
The increase in insurance rates in the year 2000 was led by jumps in employment-based insurance. However, anticipating a rising rate of unemployment, President Bush has asked Congress to approve $3 billion in “emergency grants” to states to help individuals affected by the September 11 attacks. That includes providing subsidies to help the unemployed maintain their health insurance. The President has also asked for a stimulus plan worth many billion dollars that will also cover the payment of insurance premiums covered under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). Bush also proposed allowing the states access to unused funds in the Children’s Health Insurance Program (CHIP) to help the uninsured.
Ron Pollack, executive director of Families USA, a patient-advocacy group, said, “We are pleased that President Bush recognized the need for providing health coverage assistance to recently unemployed workers and their families. Unfortunately, the President’s proposal is less than half a loaf and hardly constitutes a slice. Most of the President’s health-related relief comes from taking $11 billion in existing funds from the State Children’s Health Insurance Program (SCHIP). In effect, the President plans to take funds designed to provide coverage to low-income uninsured children and to divert those funds to recently uninsured adults. This hardly constitutes relief for needy families.” Pollack pointed out that the “unused” funds are supposed to be available to the states for at least 3 years. He said using the money in the way suggested by the Bush Administration takes funding from children who have no other access to health insurance. According to Pollack, “Recently unemployed workers and their families would be best served by providing new federal funding for people at risk of becoming uninsured.”
Elderly Patients With Supplemental Insurance More Likely to Take Statins
Medicare beneficiaries who lack a supplemental insurance policy that covers part of the cost of prescription drugs spend a disproportionately large percentage of their income on such medication and are less likely to take relatively expensive drugs such as the “statins,” even when they are prescribed, said researchers from Brigham and Women’s Hospital and Harvard Medical School in an article in the June 10, 2001 issue of the Journal of the American Medical Association (2001;286:1732–1739).
The researchers evaluated the treatment of 1908 patients aged ≥66 years with a history of congestive heart disease or myocardial infarction from the 1997 Medicare Current Beneficiary Survey. Statin used ranged from 4.1% in Medicare patients with no drug coverage to 27.4% in patients with employer-sponsored drug coverage. There was less variation in β-blocker and nitrate use. More than 36% of those with supplemental insurance took β-blockers compared with 20.7% of those without; 38% of those with supplemental insurance took nitrates compared with 20.4% of those without. Patients who had only Medicare spent 7.9% of their income on prescription medications, 4 times more than patients who were covered by employer-sponsored plans.
Computer Game Could Improve Heart Attack Symptom Recognition
A computer game developed at the University of Pennsylvania seems to teach its players to recognize the symptoms of a heart attack more readily and to prompt them to call 911 or report to an emergency rooms more quickly. In an article published in the September 2001 issue of Health Care Management Science (2001;4:213–228), Barry G. Silverman, PhD, the creator of the “Heart-Sense” game and a professor of systems engineering at the University’s schools of Engineering and Applied Science and Medicine and the Wharton School, and his colleagues described their creation of a virtual village in which players encounter created individuals whom they convince to deal appropriately with a variety of heart attack symptoms.
In preliminary results, those who played the game demonstrated that they were more likely to recognize their own heart attack symptoms and those of others and respond appropriately by calling 911 promptly to get help for themselves and other individuals. The multimedia format of the game made it more vivid for those who played it and helped them remember the symptoms better. The game can be played on most personal computers that are equipped with CD-ROMs. “It’s believed that people learn best by teaching others,” said Dr Silverman. “This study indicates that even the most rudimentary version of the Heart-Sense game improves the likelihood that patients will seek medical attention for symptoms of a heart attack.”
In the first study of the game’s effectiveness, 18 subjects played it in their homes and offices. The game was played in 1 of 4 forms, ranging from simple text on monitors to a fully interactive form, including conversations with virtual heart attack victims. Follow-up questionnaires demonstrated that all had benefited from the message of the games, but those who played the more realistic version had gained the most knowledge.
Most often, the longest delay in treatment for heart attack occurs at home because victims ignore their symptoms and refuse to seek prompt treatment by calling 911. The American Heart Association and the National Heart, Lung, and Blood Institute have called for more effective programs to reduce this initial delay in seeking treatment.