Top Workforce Trends Impacting the Healthcare Industry in 2020
Caring For The Uninsured Final 050510
1. wHite PaPer
CARING FOR THE UNINSURED
AMID FINANCIAL PRESSURES
USING TARGETED MARKETING METHODS TO INFLUENCE
PATIENT BEHAVIOR
JEFFREY S. BARKOFF
DENNIS DUNN, PHD
KENT FRANCIS
LINDA MACCRACKEN, MBA
GARY PICKENS, PHD
LEAH H. RAY, MBA
MICHAEL SHIPLEY
MEREDITH A. WELLS, MS
APRIL 2010
2. TABLE OF CONTENTS
INTRODUCTION .......................................................................................................................................... 1
THE UNINSURED POPULATION: NOT HOMOGENOUS ..................................................................... 1
UNINSURED HEALTH SERVICES UTILIZATION .................................................................................. 2
OUTPATIENT SERVICE USE DIFFERS BY PAYER GROUP ................................................................. 3
INPATIENT SERVICE USE DIFFERS BY UNINSURED PATIENTS ..................................................... 3
USING MARKETING TO INFLUENCE BEHAVIOR OF THE UNINSURED ........................................ 4
STRIVING FOR BALANCE: TACTICS FOR CONSIDERATION ............................................................ 6
MARKETING TACTICS ............................................................................................................................... 6
FRONTLINE TACTICS .................................................................................................................................7
CONCLUSION...............................................................................................................................................7
APPENDIX ................................................................................................................................................... 8
REFERENCES .............................................................................................................................................. 9
3. INTRODUCTION
Across all political affiliations, industries, and
socioeconomic backgrounds, healthcare reform ranks
among today’s most discussed topics. But in the midst of
the debate, one fact remains clear: providing care to the
uninsured segment of the population is a monumental task
of paramount importance.
The total uninsured population now includes one out of every six Americans. Estimates of the total number
of uninsured individuals ranges from roughly 46.31 to 49.72 million. The uninsured population now exceeds
the total number of Medicare beneficiaries by roughly 22 percent. Furthermore, forecasts indicate that the
number of uninsured will reach 58 million Americans by 2014.3
The cost of continuing to provide care as we do today will translate into billions of dollars in unpaid medical
bills for patients with little or no coverage. But the more hospitals and healthcare providers know about
their patients – notably the uninsured – the better equipped they will be to meet their missions, maintain a
robust community benefit, and contain costs as components of financial viability. Regardless of the future of
healthcare reform, hospitals and healthcare providers are well served to assess utilization and care patterns,
examine their patient rosters, and develop strategies to lower expenses without sacrificing quality of care.
In supporting this need, Thomson Reuters experts explored the topic of caring for the uninsured by
examining national hospital data and consumer healthcare information to articulate the unique
characteristics and behaviors of this growing population. This paper identifies distinct segments with
different utilization trends/behaviors, as well as channels and receptiveness to marketing. In addition,
Thomson Reuters developed recommendations to hospital leadership on how to provide the right care at the
right site of service to help better manage the rising costs of serving the uninsured.
The research presented here draws upon multiple sources, including the Thomson Reuters Outpatient
Procedure Estimates and consumer research from the annual Thomson Reuters PULSE™ Healthcare Survey.
THE UNINSURED POPULATION: NOT HOMOGENOUS
Uninsured – Not Necessarily Low Income or Unemployed
For many Americans, the “uninsured” – when viewed as a single group – often means those without
employment or those who cannot afford individual healthcare coverage. The uninsured are not a
homogenous group and include both unemployed and employed individuals, at various income levels, as
well as their children and other dependents. Thomson Reuters experts have found significant differences
among the various subgroups of the uninsured, including site of service preferences and health conditions.
Thomson Reuters defined four mutually exclusive segments for the uninsured, based on employment
status and income level. Key differences in behaviors of the various segments are described as follows.
• Uninsured, employed with incomes under 300 percent of the Federal Poverty Level
• Uninsured, employed with incomes above 300 percent of the Federal Poverty Level
• Uninsured, unemployed with incomes under 300 percent of the Federal Poverty Level
• Uninsured, unemployed with incomes above 300 percent of the Federal Poverty Level
Caring for the Uninsured Amid Financial Pressures 1
4. Uninsured – Low Income, not Medicaid
Not all low-income individuals qualify for government coverage through Medicaid.4 Medicaid eligibility
is based on considerations of income as well as other characteristics. Among the population groups that
generally qualify for Medicaid are children, parents of dependent children, pregnant women, the disabled,
and the elderly. The income levels at which these groups qualify differ from state to state, and group to
group. Generally, coverage for children and pregnant women is available at higher income levels, followed
by the disabled and elderly, and lastly, parents of dependent children. Childless adults who are not
disabled or elderly do not qualify for Medicaid, even at the lowest income levels.5
Uninsured Workers Across All Industries – Variations Within
The uninsured are present and working across nearly all segments of American business, even at
moderate income levels. There is a significant presence of uninsured/employed at greater than 300
percent of the Federal Poverty Line (FPL), with high concentrations in the financial services, information
technology, transportation, and utilities industries. These individuals are often the recipients of direct
marketing targeted toward the purchasing individual for self-pay insurance plans.
The construction industry, and the leisure and hospitality services industry, have the highest percentage
of uninsured/unemployed individuals below 300 percent of the poverty level. While these industries
have lower employee retention rates and may have higher incidences of on-the-job injuries, this group of
individuals also moves between employed and unemployed status more frequently. This group is often
unable to access quality health insurance given the number of workplace-related injuries that occur in
these lines of work.
Table 1: Uninsured Workers by Industry
EMPLOYED EMPLOYED UNEMPLOYED UNEMPLOYED GRAND TOTAL
UNINSURED UNINSURED UNINSURED UNINSURED
INDUSTRY PERSONS: PERSONS: PERSONS: PERSONS:
0-FPL300 FPL300+ 0-FPL300 FPL300+
Financial Activities 43% 35% 17% 6% 1,098,728
Information 41% 30% 20% 9% 456,213
Transportation and 44% 29% 22% 5% 1,340,292
Utilities
Educational and 46% 28% 22% 4% 3,576,886
Health Services
Professional and 40% 26% 28% 6% 3,149,590
Business
Wholesale and 46% 24% 25% 4% 4,499,978
Retail Trade
Manufacturing 49% 23% 24% 5% 2,264,383
Construction 41% 22% 33% 5% 3,950,430
Agriculture, 56% 18% 24% 3% 626,562
Forestry
Leisure and 50% 18% 28% 4% 4,756,268
Hospitality
Source: Bureau of Labor Statistics, Current Population Survey, March 2008 Supplement
UNINSURED HEALTH SERVICES UTILIZATION
Physician Office Visits Lower; Self-Reported Conditions Higher
For the employed and unemployed uninsured, office visits occur infrequently. Regardless of employment
status, the uninsured average 2.5 physician office visits per year – approximately half the rate of those
with insurance.
However, despite a lower number of visits to physicians’ offices, the uninsured population has below-
average health status and experiences complicating factors that negatively impact health. Unemployed,
uninsured individuals self-report heart problems, hypertension, and lung cancer at extremely high rates,
and show a high prevalence of chronic conditions. Risk factors among unemployed, uninsured patients
include: obesity, poor diet, extreme stress, depression, and anxiety.
2 Caring for the Uninsured Amid Financial Pressures
5. As a result, it’s not surprising that the uninsured often seek other locations and venues of care, including
inpatient and hospital emergency department settings.
OUTPATIENT SERVICE USE DIFFERS BY PAYER GROUP
Medicaid Usage Higher Than Uninsured
Medicaid outpatient utilization across all delivery settings, including high-cost surgical procedures,
invasive procedures, and deliveries, ranges from two to three times greater than that of the uninsured.
Uninsured Patients Seek Lower Cost Medical Therapies, Minor Procedures, and Visits
The uninsured population frequently accesses lower cost medical therapies, minor invasive procedures,
and visits (often paid directly by the patient) at hospital outpatient or non-hospital clinic settings. In this
case, the uninsured take advantage of the various charity care and community benefits provided by area
hospitals that treat patients of all payer coverage categories or those without coverage at all. It’s also
common for the uninsured to use the Emergency Department for non-emergent visits at a much higher
rate than those with private insurance. But the use of Urgent Care centers, a lower cost-of-service site,
shows below average usage rates for the uninsured population.
To have an impact on this cycle of high-cost behavior across payer groups, hospital providers and their
marketing teams could benefit from developing and delivering targeted messaging regarding the various
sites of services, and clarifying the key situations for use.
Further insights on how frequently the uninsured population accesses healthcare services are revealed in
the chart below. For all outpatient services, the uninsured access care through a physician office at a rate
67 percent lower than the Medicaid population and 53 percent below the privately insured population.
Table 2: Outpatient Visit Use Rates
DIFFERENCE IN USE RATE FOR OUTPATIENT VISITS
Visit Type % Difference - Uninsured vs. Medicaid % Difference - Uninsured vs. Private
Emergency department visit, emergent -25 -22
Emergency department visit, urgent -4 26
Office medical visit, established patient -52 -32
Office medical visit, new patient -55 -44
Source: Thomson Reuters Outpatient Procedure Estimates, 2009
INPATIENT SERVICE USE DIFFERS BY UNINSURED PATIENTS
Postponement of Care a Factor
The uninsured that are unemployed with incomes above 300 percent of the Federal Poverty Level use
hospital inpatient services at a rate of nearly three-to-one, compared to other uninsured segments.
The difference between the inpatient usage rates of these groups likely stems from the fact that the
unemployed are more likely experiencing either chronic or disabling illnesses that prevent them from
working or pursuing employment.
In addition, this segment of the uninsured is the most likely to delay or postpone care for at least 12
months, creating a vicious cycle that further exacerbates chronic conditions and leads to increased
inpatient visit rates.
The situation is complicated by the fact that the uninsured, and in particular this segment of the
uninsured, are more likely to avoid receiving the recommended screening services to maintain health.
In short, the segment that needs the most care is the one most likely to use the costliest form of care
delivery (inpatient services) rather than accessing other, less-costly sites of services capable of managing
conditions.
Caring for the Uninsured Amid Financial Pressures 3
6. Chart 1: Physician Office vs. Inpatient Encounters
60
n Employed Uninsured
Persons: 0-FPL300
50
n Employed Uninsured
Persons: FPL300+
40
Encounters
n Unemployed Uninsured
30 Persons: 0-FPL300
n Unemployed Uninsured
20
Persons: FPL300+
10
0
Physician Visits Inpatient Discharges Inpatient Nights
Source: Bureau of Labor Statistics, Current Population Survey, March 2008 Supplement
USING MARKETING TO INFLUENCE BEHAVIOR OF THE UNINSURED
A hospital’s marketing programs and targeted messages can be an effective means of directing the
various uninsured segments to appropriate and cost-effective settings of care. In fact, well-executed
marketing and communications campaigns can positively impact the overall profitability of the entire
healthcare organization.
However, there are significant differences in preferred communication channels and messages to reach
the targeted uninsured audience. In comparing the uninsured with the insured population, the uninsured
segment, on average, has less information at hand when selecting a hospital. This information disparity
suggests that concerted efforts to direct and channel care for the uninsured to specific services or sites
must be precisely designed for the intended audience.
A look at distinct marketing messaging opportunities, patient segmentation and clustering techniques,
and marketing vehicles will help illustrate how these unique groups can be best reached.
For example, the uninsured audience with incomes under 300 percent of the Federal Poverty Level,
without differentiation to employment status6, is more likely to respond to traditional methods of
communication about pursuit of services (e.g., radio, direct mail) than to Internet campaigns or
information from employers.
Chart 2: Preferred Communication Channel Compared to the Average
Preferred Info Channel: Word of Mouth n Less Than $50k
Preferred Info Channel: Employer
n Greater Than $50k
Preferred Info Channel: Physician Office
Preferred Info Channel: Internet
Preferred Info Channel: Phone
Preferred Info Channel: Direct Mail
Preferred Info Channel: Newspaper
Preferred Info Channel: Radio
Preferred Info Channel: TV
Heard/Saw Healthcare Advertising
Use Internet For Health Info Lookup
Have Internet Access
-18% -12% -6% 0 6% 12% 18%
Percent Difference from Average
Source: Thomson Reuters PULSE™ Healthcare Survey, 2009
4 Caring for the Uninsured Amid Financial Pressures
7. While hospitals have shifted their budget allocations to create a host of scalable, efficient, online health
resources (e.g., hospital Web sites, health content) that serve as patient education materials, they may
miss the targeted audiences that need these resources most. A traditional target audience analysis, based
on the HouseholdView® segmentation system, provides a window into the need to craft specific messages
for the uninsured market.
The chart below demonstrates that within the uninsured population, there are additional differences
driven by demographic details, such as age, that may be leveraged for marketing success and cost
containment.
Chart 3: Likelihood to Postpone Care
20.0% n Postponed Care:
15.0% 1 year
Percent Difference from Average
10.0% n Have PCP
5.0%
0.0%
-5.0%
-10.0%
-15.0%
-20.0%
-25.0%
-30.0%
Over-55 Segments Under-55 Segments
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Source: Thomson Reuters PULSE™ Healthcare Survey, 2009
Messaging to Uninsured Greatest/Silent Generation – Get the Doctors on Board HEALTHCARE
The Greatest/Silent Generation segment of the uninsured population, is more likely than their younger ATTITUDES
counterparts to have a primary care physician (PCP). And despite being concerned about the cost of OF FOUR
medical services, they are more likely to seek care. GENERATIONS7
In the Thomson Reuters PULSE™ Healthcare Survey, the age 55+ generations reveal strong physician Greatest/Silent
Generation
alignment and consider “Physician Referral” and “Physician Affiliation” as the most important drivers
(born before 1942)
in selecting a hospital for care. Correspondingly, strengthening physician relationships, rather than
increasing direct-to-consumer outreach, may ultimately be more advantageous in influencing individuals’ Baby Boomers
hospital selection process. Stronger physician relationships can foster paths of communication, with (born 1943–1960)
the intent of shifting use of healthcare services to the appropriate settings and thereby improving care
Generation X
management. The behavior of the over-55 uninsured population is consistent across the segment and can
(born 1961–1981)
be messaged accordingly.
Millennials (adults
Messaging to Uninsured Baby Boomers and Gen Xers – Use Direct Mail or Phone Campaigns born since 1982)
Crafting effective messaging for the under-55 populations is a more difficult task, even for those with
significant health issues, including younger uninsured segments that are at risk for hypertension,
depression, and diabetes. As the chart Likelihood to Postpone Care indicates, these individuals are less
apt to have a PCP and therefore are unable to be directed by their physician to appropriate sites of care.
Even within the under-55 uninsured population, the Baby Boomer and Gen Xer groups prove to be two
distinct populations:
• Those who would act on healthcare advertising, but do not often see it (These segments make up the
majority of the uninsured population.)
• Those who are aware of healthcare advertising, but would not act on it
Caring for the Uninsured Amid Financial Pressures 5
8. Focusing on the former, those who would act on healthcare advertising, helps marketers to connect with
a willing and receptive population. The dilemma comes in deciding which media and messages are most
important and effective. The goal in developing a strategy that best suits this audience is to identify the
most appropriate media to reach them, avenues that will draw upon their penchant to respond positively
to any form of healthcare advertising.
The two strongest media formats for this population are standard direct mail and telemarketing. Of these
two mediums, direct mail is usually the most cost-effective communication channel to connect with the
uninsured, under-55 population. In order to impact site of service selection, the goal of these mailings
should be to direct individuals to a primary care physician and encourage them to pursue necessary care.
Another tactic that has been effective with this audience is to develop a health lecture on a topic relevant
to their lives. Since many uninsured individuals in this segment struggle with chronic stress and anxiety,
health lectures on these topics are likely to resonate.
Directing this population could utilize a strategy such as:
Table 3: Potential Outreach Strategy
CALL TO ACTION MEDIA HOSPITAL GOAL
Attend a health lecture Direct mail Help establish relationship with PCP
Potential Topics: Anxiety, Depression, Phone number provided for follow-up Provide reason to see a PCP
Stress Management questions
Follow-up call after attending to make Identify critical health conditions that
an appointment with a primary care require treatment and management
physician (PCP)
Source: Thomson Reuters crmView™ Marketing Solutions, 2010
Successful efforts require consistent messaging through preferred media channels to help achieve the
goals of identifying the most appropriate site of service and disease management program.
STRIVING FOR BALANCE: TACTICS FOR CONSIDERATION
While everyone from Washington to your hometown critiques and debates the tactics for healthcare
improvement, hospitals continue to face the critical onus of delivering uncompensated care.8 There is an
immediate need to identify and achieve real solutions. Regardless of the system-wide healthcare changes
that may be on the horizon, most individual hospitals and healthcare systems face faltering business
models that are forcing reductions in services and staff.
This research raises plausible considerations for achieving a balance between meeting the mission of
serving the uninsured, benefitting the community, and also addressing healthcare budgetary constraints
while delivering a significant return to the board and other key stakeholders. Simple solutions may not
exist. However, by guiding and transferring care to more appropriate care settings, healthcare providers
have an opportunity to address the cost of care, while concurrently increasing quality of care, patient
throughput, efficiency, and ultimately reimbursable care.
To chart the roadmap toward these achievements, consider the following tactics:
MARKETING TACTICS
Focus on Patients Who Drive the Costs
A small number of patients usually drive the majority of costs. Target these patients at the right time with
the right message. Then, measure the impact of your efforts through response rate analysis and reporting,
and support continuous improvement based on your successes.
Mine the Customer Information to Gain Key Insights
Mining, modeling, and measurement are vital steps in understanding your current and anticipated patient
populations. Organizations without the internal talent or tools to achieve a comprehensive analysis can
consider partnering with healthcare-focused strategic intelligence and consulting firms and/or purchasing
market intelligence tools.
6 Caring for the Uninsured Amid Financial Pressures
9. Periodically Reevaluate Tactical Plans
Oakwood Annapolis
The tactics provided above are recommended as ongoing efforts, in lieu of one-time, evaluation processes. Hospital, part of the
Though characteristics and utilization behaviors of patients continually change, patterns emerge and Oakwood Healthcare
measurement will provide key insights in determining the effectiveness of the aforementioned tactics. System in Wayne,
Michigan, receives
These marketing tactics can help your organization gain a greater understanding of your audience, the over 70 percent of
its admitted patients
best way to reach them, and how their behavior changes over time. The frontline tactics below offer from the emergency
additional suggestions for providers to consider. department (ED).
The facility identified
FRONTLINE TACTICS patterns of its ED
“frequent fliers”
through the use of
Partner With Physicians for Continued Patient Education and Direction Thomson Reuters
Ensure information is shared with patients on appropriate care settings. For example, emergency crmView™ Marketing
department (ED) physicians may be able to share literature on other facility resources, including primary Solutions and
physicians, urgent care locations, and clinics. employed direct
mail to generate
awareness within their
Review Increased Collection Efforts (at the Time of Service) target audiences.
Increased collection efforts may discourage the uninsured from seeking care at expensive sites of service
when less expensive sites provide equally appropriate care. Yet it is important to study both the short-term They stressed the
and longer-term effects of such an effort. While the target audience may seek care at your ED much less importance of seeing a
frequently, a patient’s disease or condition may worsen, and require acute inpatient services.9 primary care physician
for non-life threatening
conditions and shared
Examine Success Stories information regarding
Identifying organizations that have successfully addressed the right care at the right site helps generate federally qualified care
ideas on what to do and who to leverage for support. centers. Among their
achievements, cost of
care decreased by $35
CONCLUSION per ED visit; improper
utilization declined by
The challenges the medical community faces in meeting the needs of the uninsured while also remaining 72 percent; physician
fiscally responsible to their own organizations are great. Although the landscape of healthcare politics referrals for patients
remains in flux and is likely to continue so for the foreseeable future, healthcare organizations can take a to more appropriate
health centers
number of practical steps to alleviate some of their most vexing financial challenges while improving their increased by 12 percent;
ability to care for the uninsured. and the ordering and
prescribing of narcotics
in the ED declined
Table 4: HouseholdView® Segments
by 10 percent. 10
SEGMENT NAME AGE MARITAL STATUS GENERATION
55. Restful Retirement 75+ Married/Married with Kids Greatest/Silent
54. Monthly Checks 75+ Married/Married with Kids Greatest/Silent
47. Golden Girl 65+ Single Female/Single Female with Kids Greatest/Silent
46. Playing Bingo 65+ Single Female/Single Female with Kids Greatest/Silent
38. Outlet Shoppers 55-64 Single Female/Single Female with Kids Boomers
37. Penny Savers 55-64 Single Female/Single Female with Kids Boomers
29. No Frills 45-54 Married with Kids Boomers
33. Simple Living 45-54 Married Boomers
17. Flying Solo 35-54 Single Female Gen X/Boomer
Source: Thomson Reuters HouseholdView®
Caring for the Uninsured Amid Financial Pressures 7
10. APPENDIX
HEALTHCARE ATTITUDES OF
FOUR GENERATIONS7
THOMSON REUTERS PULSE HEALTHCARE SURVEY
Thomson Reuters delivers unique insights into consumer healthcare behavior
GREATEST/SILENT GENERATION
(BORN BEFORE 1942): and attitudes with the proprietary PULSE™ Healthcare Survey – the largest
Attitude toward gathering healthcare ongoing, privately funded telephone healthcare survey in the United States.
information: Physician Directs Me Through the PULSE Healthcare Survey, Thomson Reuters has compiled
• Rely on personal doctors, defer to more than 100,000 household interviews annually since 1988. The survey is
physicians’ preferences conducted by telephone throughout the entire year to account for seasonality.
• Rigid definitions of good service: Each year, Thomson Reuters clients help to determine the PULSE Healthcare
the customer is always right Survey topics, ensuring the questions asked reflect the most important
• Consider only physicians and nurses industry topics. The questions are both behavioral and attitudinal in nature
as health professionals and are modeled to reflect the larger population. The PULSE Healthcare
Survey is unique in that it ties results to two proven lifestyle segmentation
BABY BOOMERS (BORN 1943–1960):
Attitude toward gathering healthcare information: systems: PRIZM® by Nielsen and HouseholdView®, a Thomson Reuters
Engage Me methodology. The use of lifestyle segmentation gives healthcare clients better
• Prefer individual engagement in healthcare insights into who is using which services and where similar households are
located within their markets.
• Seek counsel from and bring information to the
physician, and then research
physician recommendations HOUSEHOLDVIEW
• Consider only physicians and nurses as HouseholdView® is a dynamic, proprietary segmentation system for the
health professionals next generation of healthcare consumer insights. The 56 segments paint a
• Often involved in decision-making for their aging comprehensive picture of how healthcare consumers use health services,
parents, while also informing the health needs of select providers, define quality, obtain healthcare information, and respond
their own children to healthcare advertising. With a high level of sophistication for today’s
complex healthcare market place, each of the customer segments within
GENERATION X (BORN 1961–1981):
Attitude toward gathering healthcare information: HouseholdView is a unique combination of the variables determined to be the
Educate Me most predictive of consumer healthcare behavior. HouseholdView segments
• Desire to be educated and involved align with the strategic planning and marketing challenges that face the
healthcare industry today.
• Relatively healthy compared to older generations
• Curious and actively seek information
THOMSON REUTERS OUTPATIENT PROCEDURE ESTIMATES
• Assume physicians and staff are knowledgeable Thomson Reuters Outpatient Procedure Estimates predicts the total annual
• Strong interest in amenities volume of ambulatory procedures performed by ZIP code, age group, sex, site
• Likely to switch physicians and hospitals based on of service, and payer for every market in the United States. Procedures are
recent experience defined and reported by 591 categories of CPT® and HCPCS codes, which are
• More in common with the Millennial adults than with further grouped into clinical service lines as well as broad technical groups.
the Boomers To construct population-based use rates for all payers and all ambulatory
• Definition of health professionals is broad and care settings, Thomson Reuters uses proprietary and public claims, as well as
includes nurse practitioners, physician assistants, Federal surveys. The rates are adjusted to reflect local utilization patterns and
insurance companies, and pharmacies
are then applied to demographic and insurance coverage projections by ZIP
MILLENNIALS (ADULTS BORN SINCE 1982): code to estimate outpatient utilization for 2009 and 2014.
Attitude toward gathering healthcare information:
Connect with Me
• Access healthcare system through primary care
providers (PCP), urgent care centers, and Ob/Gyns
with a higher likelihood to use Ob/Gyns as PCPs
• Relatively low utilization of inpatient and
outpatient services
• When using inpatient services, most come through
maternity and emergency departments
• Enjoy and use technology
• Maintain positive, personal relationship with physician
• Seek health information from multiple sources
• More likely to switch providers if confidence in care
lost based on recent experience
8 Caring for the Uninsured Amid Financial Pressures
11. REFERENCES
1
DeNavas-Walt, Carmen, Bernadette D. Proctor, Jessica C. Smith. Income, Poverty, and Health Insurance
Coverage in the United States: 2008.
2
2009 Thomson Reuters, Insurance Coverage Estimates.
3
Abelson, Reed. Bills Stalled, Hospitals Fear Rising Unpaid Care, February 8, 2010.
(http://www.nytimes.com/2010/02/09/health/policy/09hospital.html)
4
(http://www.ache.org/Pubs/Releases/2010/TopIssues_2010.pdf) Retrieved on March 2, 2010.
5
(http://www.cms.hhs.gov/MedicaidEligibility/) Retrieved on March 2, 2010.
6
For the purposes of the following analysis, Thomson Reuters is comparing and contrasting the
behaviors of the below $50,000 and above $50,000 income households. The $50,000 line is close,
but not exactly comparable to 300 percent of the Federal Poverty Line for a family of three in the
contiguous 48 states. As such, we are using household income for approximating behavior of the
uninsured population 300 percent FPL compared to the above $50,000 household population as an
approximation for the insured segment.
7
Matching the Market: Using Generational Segments to Attract and Retain Consumers.
Thomson Reuters, 2009. pgs. 2-3.
8
Guggenheim, Ricardo, MD. Uncompensated Care is a $31 Billion Problem Waiting to be Solved.
HealthLeaders News. September 26, 2008.
9
Ibid, Guggenheim.
10
Patient Marketing Addresses E.D. Over-Utilization and Lowers Cost of Care. Thomson Reuters, 2009.
Caring for the Uninsured Amid Financial Pressures 9
