Case Study: Stakeholder Dynamics
Read the“Business Feels the Consequences of the Uninsured Problem” *****case on page 273 and consider how you would evaluate the uninsured problem from a stakeholder perspective.

Problem Statement: In your own words, describe the uninsured issue and its consequences.
Stakeholder Analysis: Analyze how this issue impacts the following major stakeholder groups:
Providers: Hospital
Providers: Physicians
Consumer: Employers
Consumer: Patient
Third- party payers (insurers)
Government

Your analysis should include the overall perspective of each stakeholder group and the impact on cost, quality, and access from each stakeholder’s perspective. Refer to Table 14-2 on the top of page 274.
Industry Perspective: Based on your stakeholder analysis, explain the healthcare industry perspective on this issue over the next three years. Provide a discussion of this issue from a cost, quality, and access point of view. Summarize the overall industry perspective.
Conclusion/Recommendations: Finally, what is your overall evaluation of the problem of the uninsured from a stakeholder perspective? Offer a recommendation(s) for how this issue can be addressed using the parity of health care model. Be sure to support your recommendation(s) with scholarly and/or peer- reviewed resources.

Printl Health Organizations: Theory, Behavior, & Development Page 1 of 2
without publisher’s prior permission. Violators will be prosecuted.
It is important to emphasize that many working Americans lack health insurance coverage.27 “Among people aged 18 to 64 who were
employed full time, about 15% lacked health insurance. However, the rate was 21% for people in the same age group who worked part
time. Poor workers were even less likely to have insurance. Almost half (48%) of poor, full-time workers were uninsured in 2000.”28
People without health insurance for the longest periods of time share these characteristics: ( 1) lack higher levels of education; (2) are 18- to
24-year-olds, followed by 25- to 34-year-olds, and then 35- to 44-year-olds; (3) are non-employed followed by intermittently employed
people.29 In Chicago, the working poor are the most likely to be uninsured; approximately 33% of the uninsured in Chicago have annual
incomes between one and two times the federal poverty line (between $16,600 and $33,200 for a family of four).30 The majority of the
uninsured in Massachusetts are employed, earn between $15,000 and $25,000 per year, and are most likely to be under the age of 35.31
To compound the problem, a study by the Center for Health System Change reported that at least 7.4 million adults with chronic conditions
lacked health insurance in 1999.32 The combination of uninsured Americans with chronic conditions, and the uninsured with acute episodic
conditions, puts a Herculean burden on the healthcare system. People without insurance (chronically and acutely ill) tend to wait to seek
healthcare; subsequently, their episodic and non-continuous care increases the acuity of their primary complaint and often is complicated
by co-morbidities. The lack of continuity of primary care for the uninsured is a serious problem and as time moves forward, this problem
becomes larger and more complex. At the front lines of care for the uninsured is the local hospital emergency department.
Case Study: Overburdened Emergency Departments Threatened by the Problem of Uninsured
Emergency departments across the nation are in crisis because of the “perfect stonn” caused by the gargantuan uncompensated care burden
of the uninsured, lower reimbursements, and government regulation (such as EMTALA).33 The Emergency Medical Treatment and Labor
Act (EMTALA), an unfunded mandate passed into law in April, 1986, requires emergency departments of participating Medicare hospitals
to screen and treat anyone with an emergency medical condition. The viability of hospitals is severely compromised by an emergency
department function that reels as the rank of the uninsured grows.33 Unless something is done (to include dealing with the nation’s
uninsured), average Americans will find it increasingly difficult to access emergency care in their communities.34,35
Americans with chronic disease and without health insurance significantly add to the overuse and abuse of hospital emergency rooms.35
Sixty-three percent of uninsured Americans with chronic diseases have incomes less than 200% of the poverty level as compared to 18% of
the insured.35 Emergency departments are overburdened by inappropriate use by the nation’s uninsured chronically ill.35 The uninsured
utilize the emergency departments of local hospitals at twice the rate of insured persons.35 The care provided in the emergency department
is not the most effective, efficient, or efficacious for primary or acute care needs.33 The results of years of emergency department misuse
include over 1100 closed emergency departments in the past decade, exhausted staff, physicians refusing to work in the ER, and inefficient
primary care.33 Emergency departments are in serious trouble given the state of healthcare, regulation, and the uninsured (uncompensated
care). It is not unusual for many hospitals around the country to simply, and often unexpectedly, close their ERS for a short time to reduce
growing financial losses.36 A significant number of emergency department patient visits are from the nation’s 42 million Americans
without health insurance.33
The financial burden of uncompensated care is severe for hospitals and physicians across the nation. “Nationally, an estimated 150,000
people owe $50,000 or more in unpaid medical bills and an estimated 20% of the 1.4 million bankruptcies each year are due at least in part
to high medical expenses.”30 In Michigan, “hospitals reported charges of over $1 .1 billion for uninsured and uncompensated care in 2000
with associated costs of $456.2 million after accounting for recoveries, offsets, and private payment receipts.”36
Georgia hospitals report spending over $1 .28 billion in indigent or uncompensated care each year.37 Missouri hospitals incurred $364.6
million in uncompensated care costs in 1995.38 “Wisconsin hospitals recently reported a 60% increase in uncompensated care since 1996
and nearly a quarter of them (the hospitals) lost money on patient care in 2001.”39 Over 82% of California emergency departments reported
financial losses totaling $325 million in 2000, over $8 million more than in 1999, and this financial burden has created an environment that
fosters closing emergency rooms; in fact, 10 emergency departments closed in 1999 and more than 60 have closed since 1990.40
Physicians are also burdened by the uninsured. According to the California Medical Association, physicians in that state lost an estimated
$130 million in 2001 due to the uninsured, uncompensated care burden.41
Case Study: Business Feels the Consequences of the Uninsured Problem
Netonly do-healthcareeosts reduce-«our natien’s ability-to compete in-the-global marketpiace, but alsethe loss of productivity due to illness
or injury is of concern to any business. For the uninsured, time away from work further complicates family financial issues but also
decreases overall productivity of the nation. Median time away from work in 2000 due to illness and injury was 6 days (median for males
6 days; females = 5 days).42 A total of 1,664,000 days away from work were reported (those that were reported) in 2000.43 In 1996,
temporary illness or injury resulted in 1,234,000 people between the ages of 20 to 64 years to miss work.44 Using the median days missing
work per person (6 days) and the number of people missing work due to temporary illness or injury (1,234,000) by the percentage of
Americans without health insurance ( 14.6% and removing the 24.7% of the uninsured that did not work), a crude estimate of workdays lost
is calculated to be nearly 814,000 days attributed to uninsured working Americans. If those Americans had health insurance, how many
days of missed work and productivity could have been avoided‘? If only 20% of those lost workdays of the uninsured could have been
avoided, over 160,000 workdays could have been added to the nation’s productivity.
How do you evaluate the problem of the uninsured from a stakeholder perspective? Use the template or model below to summarize your
thoughts and discuss this problem with others.
Describe the issue based on the topic/content area/change in your own words (2-3 sentences) (the uninsured Issue is the case study in the
chapter):
How does this topic/content area/change impact the following major stakeholder groups? Fill in Table 14-2 below (you can copy and paste
the symbols if using a computer).(3 points)
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