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Uninsured Patients More Likely to Die

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A recent study published in Archives of Surgery analyzed 687,091 patients who visited trauma centers across the nation from 2002 to 2006, finding patients without insurance almost twice as likely to die from their injuries than patients with insurance. The study used information contributed by 1,154 U.S. hospitals to the National Trauma Data Bank.

An article published in the LA Times online noted that, although several previous studies have shown the negative effects of going without health coverage, the results were still surprising to physicians. The article reported that “uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery. Overall, about 18,000 deaths each year have been traced to a lack of health insurance.”

Hospitals, however, are required to admit and treat patients regardless of coverage status. The Emergency Medical Treatment and Active Labor Act, passed in 1986, guarantees that people get all necessary emergency treatment no matter their insurance.

The researchers, hailing from Harvard University and Brigham and Women’s Hospital in Boston, also found that “patients enrolled in commercial health plans, health maintenance organizations or Medicaid” were equally as likely to die from traumatic injuries when “age, gender, race and severity of injury were taken into account.” The risk of death was 56% higher for patients covered by Medicare, which researcher Dr. Heather Rosen noted may be due to the fact that it includes many individuals with long-term disabilities. The risk of death for patients without any insurance was 80%.

The same team of researchers did a parallel study that analyzed 209,702 patients ages 18 to 30 “because they were less likely to have chronic health conditions that might complicate recovery.” The risk of death for uninsured patients in this study was 89% higher than those who were insured.

The researchers offered several explanations for their findings, including longer waits for uninsured patients to see doctors and the need for uninsured patients to visit several ERs before finding ones that will treat them. In addition, other studies show that uninsured patients “[receive] fewer services, such as CT and MRI scans” once admitted and are also “less likely to be transferred to a rehabilitation facility.” Uninsured patients may also suffer harder recoveries due to previously untreated underlying conditions.

Dr. Frank Zwemer Jr., chief of emergency medicine for the Hunter Holmes McGuire VA Medical Center in Richmond, Va., said that the types of injuries may differ, too. “Gunshot and stabbing victims – frequently younger people involved in crime – were much more likely to die from their wounds than other trauma patients tracked in the study. These people are generally uninsured, but the type of injury – not insurance status – is the reason for their higher fatality rates.”

Researchers noted that the link could be coincidental.

But, in reality, is anyone really surprised by this data? Does it not make sense that those without needed resources are more likely to suffer negative consequences? There are, of course, exceptions to most generalizations, but the above is a large part of the impetus behind health care reform.