A Shared Destiny is the fourth in a series of six reports on the problems of uninsurance in the United States. This report examines how the quality, quantity, and scope of community health services can be adversely affected by having a large or growing uninsured population. It explores the overlapping financial and organizational basis of health services delivery to uninsured and insured populations, the effects of community uninsurance on access to health care locally, and the potential spillover effects on a communitya (TM)s economy and the health of its citizens. The committee believes it is both mistaken and dangerous to assume that the persistence of a sizable uninsured population in the United States harms only those who are uninsured.
1 Front Matter; 2 Executive Summary; 3 1 Introduction; 4 2 Context for Community Effects: Uninsurance and the Financing and Delivery of Health Services; 5 3 Community Effects on Access to Care; 6 4 Economic and Social Implications of Uninsurance Within Communities; 7 5 Community Health and Uninsurance; 8 6 Summary: Conclusions and Research Agenda; 9 Appendix A: Conceptual Framework for Assessing the Consequences of Uninsurance for Communities; 10 Appendix B: Geographic Differences in Uninsured Rates; 11 Appendix C: Data Tables; 12 Appendix D: Commissioned Papers; 13 Appendix E: Glossary; 14 Appendix F: Biographical Sketches; 15 References