unded fully by the covered individuals and families. For the remaining 40 percent of the population, the delivery of health care services is either (1) funded by the federal government (for approximately 25 percent of the population, primarily through the Medicaid program), (2) funded by individuals and families in a financial position to pay for health care services at the time of delivery, or (3) seeking such services is deferred until an emergency medical situation develops. When all factors are considered, approximately 15 percent of the country's population is without any formal health care insurance coverage, although some estimates of this proportion are higher (Rosen, Fanshel, and Lutz, 1994, p. 234). Further, in most cases, these uninsured individuals are not in a financial position to fund such services as required. With the size of the American population approximating 250 million persons, the 12 percent without formal health care insurance translates into approximately 37.5 million people (Schwartz, 1995, p. 4). The large number of uninsured persons threatens the stability of the health care system (Fisher, 1994a, p. 2).
The working poor without health care insurance tend to postpone medical consultation and treatment to avoid incurring costs they cannot afford (Weissman, Stern, and Fielding, 1991, pp. 325-331). As a consequence, when they do receive health care services those services are typically more extensive and more costly than would have been the case had consultation and treatment been sought earlier.
Funding the delivery of health care services for the indigent is an issue of concern to all because the delivered services are eventually paid for by someone (Cockerham, 1992, p. 114). In some cases, state and federal welfare programs eventually pay for some of the services. In many instances, not-for-profit hospitals--particularly county and municipal hospitals--absorb many of the costs. Lastly, third...