The U.S. health care workforce’s lack of health coverage raises “important and perhaps alarming issues,” according to an article in the American Journal of Public Health‘s December issue.

In some settings — specifically residential care and nursing homes — “almost one third of all workers providing hands-on care to vulnerable adults are uninsured,” the researchers report.

The authors examine rates of uninsurance across three health care settings — ambulatory care, including home health care services; hospitals; and nursing and residential care facilities — using data from the 2004-2006 National Health Interview Survey. The authors find that 31 percent of health service workers in residential care settings and 22 percent of health service workers in ambulatory care settings have no health coverage.

PHI recently reported similar uninsurance rates for direct-care workers, who constitute the vast majority of the occupational group “health service workers.” Based on its analysis of the most recent Current Population Survey insurance data, PHI found that one-third of direct-care workers in home health care services, and nearly half of those who work directly for private households, reported having no health insurance in 2008.

The authors of the AJPH article argue that their findings raise serious public health and policy issues regarding the quality of the U.S. health care workforce. Of particular concern are “workers transmitting undetected infectious disease because they delay seeking care, and transmitting the flu because they do not receive a flu shot.”

“Poor health status and obesity among these workers could result in an increased number of lost workdays caused by illness, contributing to high turnover rates in nursing homes,” add the authors.

They conclude:

Given concerns about infectious diseases, new resistant bacterial strains, and the quality and safety of our health care institutions, it is essential that the people who work directly in these settings receive needed health care services, including recommended immunizations and primary and preventative care.

Many direct-care workers are unable to get basic preventive services and treatment because they lack insurance.

The authors recommend that states include in their Medicaid payment rates a portion targeted directly at financing health insurance coverage for health service workers. PHI has also made this recommendation in several of its studies.