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Theme Issue on Access to Health Care
Call for Papers
Drummond Rennie, MD;
Phil B. Fontanarosa, MD, MBA
JAMA. 2006;295:2182-2183.
The number of individuals in the United States who are unable to access medical care because they are underinsured or lack any insurance at all continues to increase. An estimated 61 million persons aged 19 to 64 years were uninsured or underinsured in 2003.1 The peculiarly US system of basing insurance on employment is collapsing in the face of businesses that are no longer making this same commitment to their employees. A recent analysis2 based on data from the 2001 Medical Expenditure Panel Survey found that 22 million of 112.8 million individuals who are working in the United States were not offered health insurance, and 56% of employees in firms with fewer than 25 employees had employer-based coverage. Another recent report3 indicates that the number of uninsured US citizens increased by 6 million between 2000 and 2004, with this increase primarily due to declines in employer coverage, and suggests that this trend is likely to worsen given the continued increases in health care costs and health insurance premiums. Estimates of the number of citizens who will lose their coverage when Medicaid recipients have to produce proof of citizenship after June 30, 2006, are debated, but the change in the law is predicted to add to the rolls of the uninsured.4
The current government insurance systems, such as Medicare, Medicaid, the Veterans Health Administration system and other military health care programs, and the Federal Employees Health Benefits program, exclude vast numbers of the population whose tax dollars support them. Moreover, while several proposals5-6 have been suggested to reform health care and expand insurance coverage, there has been little real progress or sustained success in achieving these goals. Recent state-based initiatives are innovative experiments that may represent viable solutions, such as legislation introducing a program that will provide nearly universal health care coverage in Massachusetts,7 and another program that will extend health coverage to all uninsured children in Illinois.8 However, that these programs are even necessary speaks volumes about the patchwork nature of the current system.
Meanwhile, millions of individuals are unable to access care because of numerous barriers including geography, racial disparities, and immigrant status—illegal, and sometimes legal. Those who lack access to needed care, which may include inability to obtain primary care, chronic care, specialist care, or timely emergency or urgent care, are at risk for serious health consequences. A recent report9 demonstrated that lacking health insurance was associated with significantly decreased use of recommended health care services for cancer prevention, cardiovascular disease risk reduction, and diabetes management among lower-income as well as higher-income adults. In addition to the concerns, burdens, and stress directly related to their illness, patients who are uninsured or underinsured also face high levels of debt, bullying from collection agencies, worry, and possible bankruptcy.1
To focus attention on and reinvigorate much-needed interest in this pressing topic, JAMA will publish a theme issue devoted to access to health care, and some of the Archives Journals will publish theme issues or devote pages to publishing articles on this topic, all in March 2007.
We invite authors to submit manuscripts on virtually any topic relevant to the issue of access to health care. High-quality original research papers that present new scientific information and solid data relevant to enhancing understanding of the health consequences and implications of inadequate access to care; evidence-based, well-thought-out manuscripts that provide evidence for or propose rational steps toward finding solutions to improving insurance coverage and enhancing access to care; and carefully conducted rigorous analyses that consider the economic ramifications of workable approaches to systemwide solutions will receive highest priority. Systematic reviews and scholarly commentaries on these and other important relevant topics are also welcome, including, but not limited to, the implications of shifting physician supply (eg, geographical movement of specialists, such as obstetricians and neurosurgeons, because of escalating medical liability premiums) on timely access to needed specialty care, as well as studies that provide comparative analyses and perspectives on insurance coverage and access to care based on experience from other countries and other health care systems.
We look forward to receiving manuscripts on access to care. Authors are encouraged to consult the Instructions for Authors10 for guidelines on manuscript preparation and submission. All submitted manuscripts will undergo JAMA's usual rigorous editorial evaluation and review. High-quality papers that are not accepted by JAMA, but may be appropriate for a more specialized journal, may be referred to one of the Archives Journals for further consideration. Manuscripts received by October 1, 2006, will have the best chance of consideration for inclusion in the access to care theme issue of JAMA.
AUTHOR INFORMATION
Financial Disclosures: None reported.
Editorials represent the opinions of the authors and JAMA and not those of the American Medical Association.
Author Affiliations: Dr Rennie (drummond.rennie{at}ucsf.edu) is Deputy Editor and Dr Fontanarosa is Executive Deputy Editor, JAMA.
REFERENCES
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1. Schoen C, Doty MM, Collins SR, Holmgren AL. Insured but not protected: how many adults are underinsured [Web exclusive]? Health Aff (Millwood). 2005;14(suppl):W5-289-W5-302.
FREE FULL TEXT
2. Collins SR, Davis K, Ho A. A shared responsibility: US employers and the provision of health insurance to employees. Inquiry. 2005;42:6-15.
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3. Holahan J, Cook A. Changes in economic conditions and health insurance coverage, 2000-2004 [Epub ahead of print]. Health Aff (Millwood). 2005;W5:498-508.
FREE FULL TEXT
4. Pear R. Medicaid hurdle for immigrants may hurt others. New York Times. April 16, 2006;sect 1:1.5. The Physicians' Working Group for Single-Payer National Health Insurance. Proposal of the Physicians' Working Group for Single-Payer National Health Insurance. JAMA. 2003;290:798-805.
FREE FULL TEXT
6. Palmisano DJ, Emmons DW, Wozniak GD. Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform. JAMA. 2004;291:2237-2242.
FREE FULL TEXT
7. Belluck P. Massachusetts legislation on insurance becomes law. New York Times. April 13, 2006:A13.8. State of Illinois All Kids Web site. http://www.allkidscovered.com/. Accessed April 19, 2006.9. Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. JAMA. 2006;295:2027-2036.
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10. Instructions for authors. JAMA. 2006;295:103-111. http://jama.ama-assn.org/ifora_current.dtl.
FREE FULL TEXT
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