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."
OTOH, gay men, who have a life expectancy of 42 years, due to the same issues of alcoholism, drug use, suicide, suceptibility to fatal STDs, smoking, and high risk taking, tend to be disproportionately better insured.
Just playing devil’s advocate here.
Of course, gay men only make up about 1% of the adult population, so there’s that to consider as well.
These are the same folks who are not going to pay for insurance under any circumstances.
GSW parients with no insurance die more frequently then those who do. And there is a down side how?
So they lumped together car crashes, falls and gunshot wounds and then pretended to adjust the data to "take into account the severity of the injuries"?
This is probably how they fudged the data, by purporting to equate a category like "gunshot wounds" with "automobile crashes" as equally severe.
So the problem of the gang-banging underclass becomes a problem of "lack of health insurance" and "not enough money spent on hospitals treating them."
And if we just pass nationalized health care, then "severe" inner-city gunshot victims will have the same survival rate as "severe" suburban auto crash victims! It's magic!
Yeah; from gunshot wounds, AIDS, STD’s, and a host of other SELF-INDULGENT/DEPENDENCY LIFESTYLE CHOICES that these parasites make.
Well said.
Might be some merit to it.
Don’t you think there’d be a strong correlation between
engaging in risky behavior, say, dealing drugs or gang-bangin’,
and not being responsible enough to buy insurance?
The “researcher” cited as a senior author of the study is an advocate of Obamacare and a talked about replacement for Teddy’s seat.
http://www.techbanyan.com/5118/dr-atul-gawande-sen-ted-kennedy-seat/
I’m not wearing my glasses today, and first glance the title read:
Uninsured Twice as Likely to Die on FR.
Very well said and I’ll add illegals to your list
Trying to simplify cause and effect does not work. So many factors.
do people not get the whole correlation/causation thing? maybe people without insurance are more likely to not know how to drive, drive cars that are less safe, and generally have higher levels of destructive behaviors. sheesh!
Sounds like most of these patients were ambulance patients with not much choice about going to the ER. They were trauma, not medical so accumulated problems isn’t what got them there.
Uninsured patients MIGHT if they are alert and talking delay refuse to go to the hospital because they can’t afford it, and then be in worse shape when they do show up. Last week I had a patient who had a first-time seizure a few hours after an auto accident. He was alert and oriented by the time we got there and refusing to go in. Major persuasion and pressure by EMTs, medics, cops, his wife finally wore him down but here was a hard-working family man putting off an evaluation he needed because he was so worried about the money.
Twice as likely? Really.
I guess there’s nothing else for us to do than to turn the health care industry over to government bureaucrats because we all know how well that works out.
LOL!
I doubt anyone except the most foolish will take this “study” seriously.
Substance-abusing street people and gang bangers don’t do as well as average people after traumatic injury. Who would have thunk it!
well now that you put it that way ... then it’s quite possible.
It will be noted that there is a law requiring ER's to take injured patients who show up for treatment.
However, there are also perfectly legal ways to dodge that law (I never heard of "patient dumping" before the law was passed). Hence the solution creates the problem.
Don't recall this being much of a problem before that law was passed in the '80's.
Of the 50 million people uninsured in the US, half are twice as likely to live in Arizona’s 15th district and half are twice as likely to be illegal aliens.
The other half are twice as likely to not exist...
But three times as likely to have voted for Obama.
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