The costs of non-insurance in Maryland

Hugh R. Waters, Laura Steinhardt, Thomas R. Oliver, Alice Burton, Susan Milner

Research output: Contribution to journalArticlepeer-review


Objectives. This study calculates expenditures and costs related to a lack of health insurance coverage in the State of Maryland. Research methods. The study is based on detailed primary and secondary data collection on the following sources of payment and care related to non-insurance: (1) uncompensated hospital care; (2) other public subsidies; (3) ambulatory services; (4) philanthropic spending; and (5) uninsured individuals' costs. Results. Expenditures by and for the uninsured in Maryland total $1.47 billion dollars. On a per-capita basis, this is equivalent to $2,371 per full-year uninsured person in the state. Twenty-seven percent of this total, or $633 per uninsured person, is paid directly by the uninsured themselves in out-of-pocket medical expenditures. The state and local governments spent $497 per uninsured person (21% of the total), and the federal government spent an additional $401 (17%). Private payers (including insurance, physicians, and philanthropy) accounted for $460 (19%). Conclusions. The sources and flows of spending on the uninsured are complex, and these expenditure levels should not be interpreted as savings that would directly result from an expansion of insurance coverage. Our results are consistent with earlier studies completed at the national level, and add considerable detail.

Original languageEnglish (US)
Pages (from-to)139-151
Number of pages13
JournalJournal of Health Care for the Poor and Underserved
Issue number1
StatePublished - Feb 2007


  • Access
  • Demand
  • Health care costs
  • Health insurance
  • Safety net providers
  • Uninsured
  • Utilization of services

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Social Sciences (miscellaneous)


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