Uninsured more likely to die younger

emergency roomWhether you're a child rushed to an emergency room for care or an adult who has put off preventive medical care, if you don't have health insurance, you are more likely to die. That's been confirmed by three different health studies.

  • Harvard University found that large numbers of uninsured adults have chronic illnesses that are undiagnosed and under-treated, which means they are not getting treatments that could prevent strokes, heart attacks, amputations and kidney failure.
  • A second Harvard University study found that uninsured patients with traumatic injuries, such as car crashes, falls and gunshot words were almost twice as likely to die in the hospital as similarly injured patients with health insurance.

All three studies show the dramatic costs of being uninsured. Researchers in all three studies tried to pin down the reasons behind the differences.

In the Johns Hopkins study, researchers looked at 23 million hospital records and found that 16,787 children died in hospitals between 1988 and 2005 because they lacked medical coverage. While the researchers could not say the children would have survived with health insurance, they do think some may have been saved. They believe that children are sicker when they get to the hospital if the family does not have health insurance.

In the Harvard study that looked at uninsured adults, the researchers analyzed the health conditions of 16,000 uninsured adults. They found 46% of the uninsured adults were unaware they had diabetes and 52% had high cholesterol but didn't know it. They also found that 77% of the uninsured had poorly controlled cholesterol and 58.3% had poorly controlled blood pressure.

The second Harvard study on emergency care is the most distressing. While most think that emergency care is equitable, the Harvard study appears to prove it is not. Researchers could not pin down one reason for the fact that the uninsured are almost twice as likely to die after a trauma. Some of the reasons suggested include delays being transferred from hospital to hospital, as well as the fact that they get a different level of care. Also the fact the some may have difficulty communicating to doctors could be a factor.

After taking the severity of injuries and patient's race, gender and age into account, the researchers found something even more troubling -- the uninsured were 80% more likely to die than those with insurance, even low-income patients insured by the government's Medicaid program.

Federal law requires hospital ERs to treat all patients who are medically unstable. But once a patient is stabilized, they can be sent to another hospital. Private hospitals tend to stabilize patients and then send the uninsured elsewhere. A transfer can worsen a patient's condition and this may be a factor in the higher death rates, but researchers did not confirm that.

The study found that the overall death rate was 4.7 percent, so most do survive their emergency room care. But the commercially insured patients had a death rate of 3.3%, while the uninsured patients death rate was almost double that at 5.7%. The findings were based on an analysis of data from the National Trauma Data Bank, which includes more than 900 U.S. hospitals.

Clearly more research needs to be done . Are people dying more often and younger because they don't have health insurance? I fear the answer is yes.

Lita Epstein has written more than 25 books including Surviving a Layoff: A Week-By-Week Guide to Getting Your Life Back Together.
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