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Tuesday, September 28, 2004

"The Uninsured are Sicker and Die Sooner"

Many people believe that the uninsured are able to get access to health care: at the emergency room, at the county public hospital, surely somehow. A 1999 poll found that 57% of Americans believed that the uninsured are "able to get the care they need from doctors and hospitals." Although it's true that the uninsured get some care, they get a lot less than those with insurance, and suffer worse outcomes. In short, a lack of health insurance is deadly.

The Institute of Medicine has issued a series of reports about the health outcomes of the uninsured. The IOM is part of the National Academy of Sciences, so these are consensus reports of a committee of experts, and about as authoritative as it gets. The overall conclusion is:
• Uninsured adults have a 25 percent greater mortality risk than adults with coverage. About 18,000 excess deaths among people younger than 65 are attributed to lack of coverage every year.
Now, insurance coverage is obviously correlated with age, income, race, and other factors that affect health. The studies discussed by IOM did try to control for these factors, but probably didn't succeed perfectly. So I was most impressed by the findings that among people with the same illness, the uninsured got less care and were more likely to suffer bad outcomes. The IOM found this over and over: diabetes sufferers got less regular exams, AIDS patients got less effective drugs, even uninsured car crash victims receive less treatment:
To see how uninsured patients fare in a hospital setting, the committee focused on two conditions for which most people are treated regardless of whether they are insured: traumatic injuries and heart attacks. It found that uninsured persons with traumatic injuries are less likely to be admitted to the hospital, receive fewer services if they are, and are more likely to die than insured victims. One statewide study of car crash victims discovered that uninsured victims had a 37 percent higher mortality rate. Another statewide study found that although uninsured trauma patients were just as likely to be placed in intensive care, they were less likely to be operated on or to receive physical therapy.


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