Serious Illness and Private Health Coverage: A Unique Problem Calling for Unique Solutions

Author:

Kinney Eleanor D.,Freund Deborah A.,Camp Mary Elizabeth,Jordan Karen A.,Mayfield Marion Christopher

Abstract

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill.

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

Reference49 articles.

1. 37. See supra note 19.

2. 19. To measure morbidity, we identified twenty-three separate categories of serious conditions that could affect all major organ systems. (These included heart disease, diseases of the nervous system, lung diseases, diseases of the glandular system, kidney diseases, liver diseases, intestinal diseases, skeletal diseases, muscle diseases, diseases of the immune system, drug or alcohol addiction, serious mental illness, treatment for high cholesterol, and cancer.) Respondents were asked to self-report whether they had any of these conditions. For analysis, data were grouped into the following categories: (1) no conditions, (2) one or two morbid conditions, and (3) more than two morbid conditions. In the South Bend Sample, respondents with one or more morbid conditions were placed in the Seriously Ill Subsample. All respondents in the Breast Cancer Sample had at least one morbid condition—cancer.

3. 28. We defined family income as “low income” (<$25,000), “moderate income” (between $25,000 and $50,000), and “high income” (>$50,000).

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