The Ethical Principles in Health Care Organization

            Improving Access to Health Care for the Uninsured.


             For decades, the American system of health care has relied primarily on employer-sponsored insurance programs as a gateway through which individual's access health care services. Gaps have been filled in through public insurance programs - such as Medicare, Medicaid, the State Children's Health Insurance Program (SCHIP) and other more locally-based programs - to cover elderly, disabled and certain low income populations who cannot access the employer-based market. In addition, the government (federal, state and local) provides certain limited subsidies (e.g., tax deductions for the self-employed) for individuals to purchase insurance policies in the private market on their own. .

             While this system has worked effectively for many Americans, it has left behind a significant number - approximately 42 million - who lack any form of health insurance coverage. For these individuals, the country has developed an institutional health care safety net to ensure that they nevertheless receive access to needed care. This institutional safety net is comprised of the many hospitals, clinics and individual providers who serve all who seek their care without regard to ability to pay. Most of these providers receive some support for the uncompensated care they provide through various public programs (on the federal, state and local levels). .

             America has long relied on this two-tiered approach to addressing the problem of the uninsured: expanding access to insurance coverage while providing financial support to safety net providers serving the uninsured. Some policymakers prefer to emphasize coverage over institutional support for providers, others might tip the balance in the other direction. But the two strategies are inexorably linked: if we do not expand insurance coverage we will need a strong system of safety net providers to serve the higher number of uninsured; conversely, if we do not adequately support safety net providers we will need to ensure that individuals can get care on the private market meaning they will need coverage.

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