Expenditures for the uninsured in Maryland totaled
$1.47 billion in FY2002, according to an analysis conducted
by researchers at the Johns Hopkins
Bloomberg School of Public
The sum equates to $2,371 per individual without
health insurance — paid for by state and federal
funds, private insurance companies, physicians, charities
and the uninsured themselves. The results of the study are
published in the February edition of the Journal of
Health Care for the Poor and Underserved.
"The lack of health insurance coverage carries serious
financial consequences, both for individuals and Maryland
as a whole. Our study provides detailed estimates of the
magnitude of the costs of having an uninsured population,"
said Hugh Waters, a health economist in the Bloomberg
School's Department of
International Health and lead author of the study. "Our
results highlight the important implications for policies
to expand insurance coverage. Many of the costs of medical
services that would be consumed by those newly insured
under an expansion are already paid for, either by the
uninsured themselves or by others."
The $1.47 billion figure represents direct
expenditures by and for the uninsured in FY2002 and does
not include losses to individuals in terms of decreased
health status and increased uncertainty. Of the $1.47
billion, $438 million was spent directly by uninsured
individuals as out-of-pocket health care expenditures.
According to the study, the health system — including
public and private health care payers, philanthropy and
private physicians — spent $1.08 billion on the
uninsured. Public health programs accounted for $462
million of this amount. Uncompensated hospital care
accounted for $227 million, a figure that the researchers
said was a conservative estimate of the percentage of
charity care that goes to uninsured patients rather than
insured ones and to bad debt reported by hospitals.
The state government paid the largest share of
expenditures, spending $334 million on the uninsured in
FY2002; of that total, $311 million went to public health
programs that provided services for uninsured individuals.
The state also contributed $20 million for uninsured
hospital patients through hospital payment rates and in
funds paid to Federally Qualified Health Centers and
school-based health programs. The federal government paid
$139 million for the uninsured through the hospital payment
system, and also contributed $138 million through public
health programs and Federally Qualified Health Centers.
Local governments directly contributed $10 million.
Private payers (private insurance, private physicians
and philanthropy) contributed $318 million in direct
expenditures for the uninsured. Private insurance companies
paid $95 million for the uninsured through hospital rates
under Maryland's all-payer system, an amount reflected in
higher insurance premiums for privately insured
individuals. In addition, private physicians contributed an
estimated $211 million in charity care, which is defined as
uncompensated care provided to uninsured individuals.
Private philanthropic spending accounted for an additional
For the study, the researchers analyzed data related
to the payment of health care for uninsured patients. They
reviewed records on uncompensated hospital care, public
health care subsidies, ambulatory services, philanthropic
spending and expenditures by uninsured individuals. The
data covered expenditures from July 2001 to June 2002.
"The Cost of Noninsurance in Maryland" was written by
Waters, Laura Steinhardt, Thomas R. Oliver, Alice Burton
and Susan Milner.
The study was completed under a grant from the Health
Resources and Services Administration and in conjunction
with the Maryland Department of Health and Mental