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Am Fam Physician. 2000;62(2):295-296

Commonwealth Report Highlights Lack of Insurance Among Young Adults

A new report from The Commonwealth Fund reveals that 12 million persons in their 20s do not have health insurance. These young adults are twice as likely to be uninsured as children or older adults and account for more than 25 percent of the nation's 44 million uninsured. As a result, many delay seeking medical treatment when they are sick and do not access preventive health care. Seventy-five percent of these 12 million young adults have incomes below 200 percent of the poverty level (about $17,000) and 75 percent do not have the option of employer-sponsored insurance, either because their employer does not offer coverage or because they are ineligible to participate in the plan. Copies of the report, titled “On Their Own: Young Adults Living Without Health Insurance,” are available by calling 888-777-2744 and ordering publication no. 391. The report is also on the Fund's Web site at

New E&M Documentation Guidelines Are Unveiled by HCFA

On June 22, the Health Care Financing Administration (HCFA) unveiled new draft documentation guidelines for evaluation and management (E&M) services. When finalized and pilot tested, these guidelines will replace the current ones. The E&M guidelines were originally developed in 1995 and modified substantially in 1997 to include more detail. However, many practicing physicians objected to the revision, which they felt was too complicated. HCFA committed to consider alternative approaches, which ultimately led to the proposed 2000 guidelines. These are based on the 1995 guidelines but have been further simplified to minimize counting. HCFA plans to develop specialty-specific vignettes for multisystem examinations, single-system examinations and medical-decision making to be used as guides for physicians and for medical reviewers. Although a specific implementation date has not been determined, HCFA officials indicated that the target is 2002. In the interim, physicians will continue to be able to use the 1995 or the 1997 guidelines, as has been the case since April 1998.

IOM Recommends Revamping the Nation's Immunization System

A new report from the Institute of Medicine (IOM) of the National Academies warns that the nation's system for providing vaccinations is weakening in spots, increasing the risk of disease outbreaks. Although current immunization rates are high, the report reveals a system facing new responsibilities, and shrinking or uncertain resources, which leave it ill-equipped to meet future needs. The IOM calls for an overhaul of the way the system is financed, including an investment of more than $1.5 billion over five years by federal and state governments. Every day, 11,000 children are born in the United States, all of whom require a series of vaccinations. If the system cannot keep up and immunization rates fall, the risk of vaccine-preventable disease outbreaks will increase, the report emphasizes. “The system is still strong, but it is beginning to show signs of strain, and such warnings are too risky to ignore,” said Bernard Guyer, M.D., M.P.H., chair of the committee that wrote the report, and chair, department of population and family health sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore. More information on the report can be found on the Web site of the National Academies at A copy of the report, “Calling the Shots: Immunization Finance Policies and Practices,” can also be ordered by calling 202-334-3313 or 800-624-6242.

Surgeon General Calls for Public Involvement in Children's Oral Health

At the first-ever national meeting on children and oral health, health care leaders and ethicists called for everyone involved in a child's life, including parents, day care workers, school nurses, preschool teachers and primary health care professionals, to become active in ensuring a child's oral health, thereby improving the child's overall health. The conference was convened by Surgeon General David Satcher, M.D., Ph.D. Citing a link between oral and overall health, conference participants, which included parent and advocacy groups, emphasized the need for public policies to improve access and reduce disparities, especially among poor and minority children and those with special health needs. Oral health encompasses all features, normal or abnormal, of the oral, dental and craniofacial tissues, collectively known as the craniofacial complex. A report from the conference notes that the most common childhood disease is tooth decay. “Oral health is important to all children,” Dr. Satcher said. “The devastating consequences of untreated disease can affect children's health and well-being, causing pain and suffering, time lost from school, loss of permanent teeth, self-consciousness and loss of self-esteem, and even more severe complications in children with coexisting medical conditions. There are profound disparities in access to oral health care and outcomes for children at risk because of their socioeconomic status or their special health needs. Unless these disparities are addressed, millions of children will continue to be affected.” The conference was convened to focus the attention of the public and policy makers on children's oral health challenges highlighted in the surgeon general's report on oral health that was released in May 2000. “Oral Health in America: A Report of the Surgeon General” underscores the growing recognition that oral health is linked to overall health.

EPA Calls for Restrictions on the Use of Chlorpyrifos

The Environmental Protection Agency (EPA) is calling for restrictions on the use of chlorpyrifos, an active ingredient in Dursban, the most widely used pesticide. Scientific research showed that the substance caused brain damage in rats. The agency found that allowable levels of the chemical, which has been available for more than 30 years, posed an unacceptable risk to children. Dow Chemical Co., which manufactures Dursban, agreed to halt production of Dursban for household use. An agreement allows continued use of chlorpyrifos on many crops, but bans its use near schools, day care centers and homes.

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