Posted on February 22, 2002

1 in 8 Health Care Workers Lack Health Insurance


Brady Case (617) 308-7035
Quentin Young, MD (312) 782-6006
Don McCanne, MD (949) 493-3714

1 in 8 Health Care Workers Lack Health Insurance

Harvard Study Finds Coverage Falling Fast for Health Personnel and Their Children, Particularly in Private Health Sector

A study published in today’s American Journal of Public Health finds that one out of every 8 health care workers lacks medical insurance, far more than a decade ago. The children of health personnel also suffered declining health coverage over the decade and now account for one in ten uninsured children in the US.

The study, by Harvard researchers Drs. David Himmelstein, Steffie Woolhandler, and Harvard medical student Brady Case, analyzed data from a national survey of approximately 150,000 US residents conducted annually by the Census Bureau.

1.36 million health care personnel were uninsured in 1998, up 83.4% from 1988. The proportion uninsured rose from 8.4% to 12.2%. Declining coverage rates in the growing private-sector health care workforce—and falling health employment in the public-sector, which provided health benefits to more of its workers—accounted for the increases. The authors argue that the growth of for-profit medicine during the 90s, and price pressures from managed care, led many health institutions to cut workers’ benefits. In effect, investors and executives gained at the expense of health personnel and their children. In 1998, 1.12 million uninsured children lived in households with a health care worker, accounting for 10.1% of all uninsured children in the U.S.

The study analyzed all employees in physicians’ offices, hospitals, nursing homes and other health services settings. Physicians, nurses, managers, aides, food service, cleaning, building service, and laundry workers, and clerical and administrative support workers were among the groups examined.

Insurance coverage fell for virtually every health occupation in every type of institution, though some groups fared worse than others. The number of uninsured health workers in the private sector doubled over the decade while in the public sector the figure declined. In 1998, 20.0% of personnel in nursing homes were uninsured—more than in other health settings. Among occupational groups aides experienced the highest rate of uninsurance—23.8%. Even among physicians, more than 1 in 20 (5.4%) were uninsured. Black and Hispanic personnel were at least twice as likely as white health personnel to lack insurance. Geographic variations were considerable; Texas had the worst record.

The falling coverage over the past decade is particularly worrisome because it occurred during a record economic boom. An even steeper increase in uninsurance is likely in the current recession.

“Over the past decade we’ve learned that for-profit hospitals and dialysis clinics have high death rates; that for-profit HMOs and nursing homes score lower on quality; and that health care fraud is epidemic. Now we learn that market medicine means not only poor care and high prices for patients, but mistreatment of health workers.” said Brady Case, a medical student at Harvard and lead author of the study. “It’s perverse. The health care system, squeezed by Wall Street, is consigning its own workers and their families to the ranks of the uninsured.”

Dr. Don McCanne, President of Physicians for a National Health Program, commented: “In denying care to caregivers, our health system defies the Golden Rule. And it’s not only wrong, but dangerous. When a nurse with a cough or a kitchen worker with hepatitis can’t afford care, patients are at risk. It’s time for the U.S. to adopt a single payer national health insurance program.”

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Physicians for a National Health Program (PNHP) is an organization of over 9,000 physicians that support universal access to health care. PNHP was founded in 1987 and has chapters across the U.S. For local contact information or copies of “No Care for the Caregivers: Declining Health Insurance Coverage for Health Care Personnel and Their Children, 1988-1998” (Am J Public Health. March 2002) call the PNHP headquarters in Chicago at (312) 782-6006.

- Brady Case is a medical student at Harvard.
- Dr. Quentin Young is an internist and former President of the American Public Health Association. He also serves as the National Coordinator of Physicians for a National Health Program
- Dr. Don McCanne is the National President of PNHP and a retired family physician.
- Drs. David Himmelstein and Steffie Woolhandler are currently on vacation. They may be reached at their clinical offices at (617) 665-1032 starting February 28.