1 Access to Medical Care for Work-Related Injuries and Illnesses: Why Comprehensive Insurance Coverage is Not Enough to Assure Timely and Appropriate Care

Access to timely and appropriate medical care is widely perceived to be a major problem in the United States. The predominant cause of this problem, according to many authorities, is the lack of health insurance for large segments of the population (Bodenheimer and Grumbach 1998; Millman 1993; Berk et al. 1995). The ranks of the uninsured have continued to swell during the past decade. As of 2001, about 41 million Americans were without basic health insurance (U.S. Census Bureau 2003). In addition, the rising cost of insurance has made it difficult for many low-income families to afford private health insurance and, partly as a result, enrollment in Medicaid and other government assistance programs has soared in recent years (Ellis et al. 2000). Over 40 million people in the United States are covered by Medicaid in 1998 and an additional 4.6 million children by State Children's ' Health Insurance Programs as of 2001 (Toner 2003; Child Welfare League 2003). Even for those fortunate enough to have health insurance coverage, recent trends towards increasing premiums, co-payments, deductibles, and other forms of cost-sharing, have increased the difficulty many individuals face in securing appropriate medical care for themselves and their families. By contrast, the medical care benefits available to injured workers under state workers&apos