would either stabilize costs or reduce the rate of increase. Health care services funded by government received special scrutiny. None of the approaches thus far attempted has proven to be particularly successful.
Approximately 60 percent of the American population is covered by private health care insurance programs (Congressional Budget Office, 1993, p. 15). Most of these programs the very great majority are either fully or partly funded by employers, while the remainder are funded fully by the covered individuals and families. For the remaining 40 percent of the population, the delivery of health care services is either funded by the federal government (for approximately 25 percent of the population, primarily through the Medicaid program), or by individuals and families in the financial position to pay for health care services at the time of delivery, or deferred. When all is said and done, approximately 12 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, 1993, p. 234). Further, in most cases, such 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 30 million people (Bureau of the Census, 1993, p. 5).
Medicaid must also be prepared to deal with the approximately 30 million persons who are without any formal health care insurance coverage, and are not in a financial position to fund such services as required. 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 c...