Posted on 11/17/2009 12:18:02 PM PST by presidio9
Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study.
The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.
"This is another drop in a sea of evidence that the uninsured fare much worse in their health in the United States," said senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist.
The study, appearing in the November issue of Archives of Surgery, comes as Congress is debating the expansion of health insurance coverage to millions more Americans. It could add fodder to that debate.
The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens, leaving about 50 million of America's roughly 300 million people uninsured. President Barack Obama, who took office in January, campaigned on a promise of offering affordable health care to all Americans.
The researchers couldn't pin down the reasons behind the differences they found. The uninsured might experience more delays being transferred from hospital to hospital. Or they might get different care. Or they could have more trouble communicating with doctors.
The hospitals that treat them also could have fewer resources.
"Those hospitals tend to be financially strapped, not have the same level of staffing, not have the same level of surgeons and testing and equipment," Gawande said. "That also is likely a major contributor."
Gawande favors health care reform and has frequently written about the inequities of the current system.
The researchers took into account the severity of the injuries and the patients' race, gender and age. After those adjustments, they still found the uninsured were 80 percent more likely to die than those with insurance — even low-income patients insured by the government's Medicaid program.
"I'm really surprised," said Dr. Eric Lavonas of the American College of Emergency Physicians and a doctor at Denver Health Medical Center. "It's well known that people without health insurance don't get the same quality of health care in this country, but I would have thought that this group of patients would be the least vulnerable."
Some private hospitals are more likely to transfer an uninsured patient than an insured patient, said Lavonas, who wasn't involved in the new research.
"Sometimes we get patients transferred and we suspect they're being transferred because of payment issues," he said. "The transferring physician says, 'We're not able to handle this."'
Federal law requires hospital ERs to treat all patients who are medically unstable. But hospitals can transfer patients, or send them away, once they're stabilized. A transfer could worsen a patient's condition by delaying treatment.
The researchers analyzed data on nearly 690,000 U.S. patients from 2002 through 2006. Burn patients were not included, nor were people who were treated and released, or dead on arrival.
In the study, the overall death rate was 4.7 percent, so most emergency room patients survived their injuries. The commercially insured patients had a death rate of 3.3 percent. The uninsured patients' death rate was 5.7 percent. Those rates were before the adjustments for other risk factors.
The findings are based on an analysis of data from the National Trauma Data Bank, which includes more than 900 U.S. hospitals.
"We have to take the findings very seriously," said lead author Dr. Heather Rosen, a surgery resident at Los Angeles County Hospital, who found similar results when she analyzed children's trauma data for an earlier study. "This affects every person, of every age, of every race."
There is a tendency to characterize the poor as irresponsible, drug-abusing, parasitic criminals. That’s not the whole story.
I have an acquaintance who was diagnosed with bladder cancer some 5 years ago. If he’d been poor, nobody would have diagnosed it in the first place, for he’d never have been able to see a doctor. As it happened, he’s very well-off, and has platinum-class health insurance. Therefore, he got regular checkups, got an early detection of the problem, got thorough and skillful treatment, got followup care and regular testing to catch any recurrence anywhere in his body. Therefore he’s still alive and well, five years later. The only difference between him and a dead man is money. He could be a devil, a drug-crazed psycho, but as long as he has money he’ll get first-rate medical care.
And that’s the way of the world, which no govt will ever change.
I agree totally. If anything, you die in the ER because you’ve been waiting in line too long.
I had an MI in December of 08, had hubby take me to the nearest ER, it was full of people who were not bleeding, unconscious, etc., but most of them were either sneezing coughing or vomiting into a bag. I, on the other hand, was having a heart attack.
“Sorry, all the trauma rooms are full you will have to wait” Hubby tapped the shoulder of a lady next to him who in very broken English told him where the next closest ER was. He took me there. Campus hospital, I was taken in immediately and diagnosed within a couple of hours.
In the other place, I would have been dead on the floor. And I have EXCELLENT insurance. In Arizona.
The moral of the story: Get insurance.
NEWSFLASH! Those unlikely to purchase insurance are twice as likely to act in ways that lead to ER DEATHS!
(see, we can play the word game, too)
Yep, and people with insurance (I believe it said “commercial insurance” so they were ignoring medicare/medicaid and state-run programs), tend to live in better areas, and have better hospitals.
Which means that, if you simply gave the people insurance, it wouldn’t help — they’d still go to the same poor hospitals, and get the same treatment, and have the same outcomes.
They didn’t adjust for other factors. My guess is that if they had compared within each ER, they’d find no correlation, and if they compared the wealth of the neighborhood where the ER was located, they’d find the disparity there.
In fact, they probably KNOW that, but needed to hide the facts to perpetuate the lie that people are dying because they don’t have insurance.
Of course, I really think people DO die more if they don’t have insurance, and some people might well be dying because they don’t have insurance. But that’s because they simply don’t care about themselves enough to spend some money on their health care.
Hey isn’t this why Michelle Obama got paid the big bucks?
“Federal law requires hospital ERs to treat all patients who are medically unstable. But hospitals can transfer patients, or send them away, once they’re stabilized. A transfer could worsen a patient’s condition by delaying treatment.”
So they should die because they don’t have insurance? I didn’t have insurance, but paid for my bill in less than 6 months. It was cheaper than paying for insurance. A lot of healthy people pay cash for their care. Why shell out a $1000 or more per month, year after year, if you are young and healthy, when it’s cheaper to pay as you go...for the most part.
next time go in an ambulance, they are the first ones in. You can be bleeding all over the place, gasping for breath and you wait, but when an ambulance patient comes in they get right in even if there is really not much wrong with them.
“So they should die because they don’t have insurance? I didn’t have insurance, but paid for my bill in less than 6 months.”
Yes, as that would be the best way to encourage deadbeats from not buying insurance. Otherwise, those deadbeats that refuse to carry insurance will continue to mooch off the American tax payer for their medical care.
And paying a medical bill in six months is not good enough as hospitals and doctors deserve their money soon after service.
The key isn’t WHY insurance should be made more affordable, but HOW. The Jackasses’ plan is asinine. The Boehner plan is worth a try.
When I was 18, I broke my pelvis in an accident. Someone drove me to the emergency room (at a for-profit hospital). I ended up being admitted into the hospital for 11 days. I didn't have insurance, nor did anyone bring up the subject. I received the care. After discharge, I had follow up doctor visits. I applied for state aid after the fact, and most of the bill was taken care of; I paid the rest off at about $20 per month.
When I broke my arm a couple years ago, I drove myself to the emergency room. At that hospital, they did ask for insurance; I showed them my Tricare card and never heard about the matter again.
I'm thinking that the hospital location may be more of a factor in this than anything else; hospitals in areas where people aren't as likely to get health insurance are more likely to be swamped with non-emergency/non-urgent cases than other hospitals. The lack of health insurance is a symptom; it's not the cause of higher mortality.
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