Isenberg Erin, Harbaugh Calista
Department of General Surgery, University of Texas at Southwestern, Dallas, Texas.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Clin Colon Rectal Surg. 2024 May 15;38(1):49-57. doi: 10.1055/s-0044-1786398. eCollection 2025 Jan.
Health insurance plays a critical role in access to and delivery of health care in the United States. As the only industrialized nation without universal health coverage, Americans without adequate insurance (i.e., uninsured or underinsured individuals) face numerous obstacles to obtaining necessary health care. In this article, we review the mechanisms by which inadequate insurance leads to worse clinical outcomes in patients with common benign and malignant colorectal pathologies. We then discuss several evidence-based solutions for improving access to optimal colorectal care for these patients. These include increasing access to and affordability of health insurance, mitigating disparities between differently insured populations, strengthening the health care safety net, and tailoring outreach and clinical decision-making for the uninsured and underinsured. By exploring the nuance and impact of inadequate insurance coverage, we ultimately seek to highlight critical opportunities for future research and advocacy within the realm of insurance design and policy.
在美国，医疗保险在获得医疗保健服务方面发挥着关键作用。作为唯一没有全民医保的工业化国家，没有足够保险的美国人（即未参保或保险不足的个人）在获得必要医疗保健方面面临诸多障碍。在本文中，我们回顾了保险不足导致常见良性和恶性结直肠疾病患者临床结局更差的机制。然后，我们讨论了几种基于证据的解决方案，以改善这些患者获得最佳结直肠护理的机会。这些措施包括增加医疗保险的可及性和可负担性、缩小不同参保人群之间的差距、加强医疗安全网，以及针对未参保和保险不足者开展宣传和临床决策。通过探讨保险覆盖不足的细微差别和影响，我们最终旨在突出保险设计和政策领域未来研究和宣传的关键机会。
