• New study finds 45,000 deaths annually linked to lack of health coverage

    Uninsured, working-age Americans have 40 percent higher death risk than privately insured counterparts

    Why We Do What We Do

    September 17, 2009
    By David Cecere, Cambridge Health Alliance


    Nearly 45,000 annual deaths are associated with lack of health insurance, according to a new study published online today by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

    The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

    “The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

    The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking into account education, income, and many other factors, including smoking, drinking, and obesity. It estimated that lack of health insurance causes 44,789 excess deaths annually.

    Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

    Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease. An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths, as the uninsured are more likely to go without needed care. Another factor contributing to the widening gap in the risk of death between those who have insurance and those who do not is the improved quality of care for those who can get it.


    The researchers analyzed U.S. adults under age 65 who participated in the annual National Health and Nutrition Examination Surveys (NHANES) between 1986 and 1994. Respondents first answered detailed questions about their socioeconomic status and health and were then examined by physicians. The CDC tracked study participants to see who died by 2000.


    The study found a 40 percent increased risk of death among the uninsured. As expected, death rates were also higher for males (37 percent increase), current or former smokers (102 percent and 42 percent increases), people who said that their health was fair or poor (126 percent increase), and those who examining physicians said were in fair or poor health (222 percent increase).


    Steffie Woolhandler, study co-author, professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance, noted: “Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.”

    “The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance,” remarked David Himmelstein, study co-author, associate professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance.

    “Even this grim figure is an underestimate — now one dies every 12 minutes.”

    Other authors include Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein. The study was supported by a National Service Research Award.


    SOURCE Harvard Gazette

    Nicole Bengiveno/The New York Times Researchers analyzed data from more than 23 million children’s hospitalizations from 1988 to 2005

    Hospitalized Children Without Insurance Are More Likely to Die, a Study Finds

    Uninsured children who wind up in the hospital are much more likely to die than children covered by either private or government insurance plans, according to one of the first studies to assess the impact of insurance coverage on hospitalized children.

    Researchers at Johns Hopkins Children’s Center analyzed data from more than 23 million children’s hospitalizations in 37 states from 1988 to 2005. Compared with insured children, uninsured children faced a 60 percent increased risk of dying, the researchers found.


    The authors estimated that at least 1,000 hospitalized children died each year simply because they lacked insurance, accounting for 16,787 of some 38,649 children’s deaths nationwide during the period analyzed.

    “If you take two kids from the same demographic background — the same race, same gender, same neighborhood income level and same number of co-morbidities or other illnesses — the kid without insurance is 60 percent more likely to die in the hospital than the kid in the bed right next to him or her who is insured,” said David C. Chang, co-director of the pediatric surgery outcomes group at the children’s center and an author of the study, which appeared today in The Journal of Public Health.

    Although the research was not set up to identify why uninsured children were more likely to die, it found that they were more likely to gain access to care through the emergency room, suggesting they might have more advanced disease by the time they were hospitalized.


    In addition, uninsured children were in the hospital, on average, for less than a day when they died, compared with a full day for insured children. Children without insurance incurred lower hospital charges — $8,058 on average, compared with $20,951 for insured children.


    In children who survived hospitalization, the length of stay and charges did not vary with insurance status.

    The paper’s lead author, Dr. Fizan Abdullah, assistant professor of surgery at Johns Hopkins, dismissed the possibility that providers gave less care or denied procedures to the uninsured. “The children who were uninsured literally died before the hospital could provide them more care,” Dr. Abdullah said. Furthermore, Dr. Abdullah said, indications are that the uninsured children “are further along in their course of illness.”

    The results are all the more striking because children’s deaths are so rare that they could be examined only by a very large study, said Dr. Peter J. Pronovost, a professor of surgery at Johns Hopkins and an author of the new study. “The striking thing is that children don’t often die,” Dr. Pronovost said. “This study provides further evidence that the need to insure everyone is a moral issue, not just an economic one.”

    An estimated seven million children are uninsured in the United States, despite recent efforts to extend coverage under the federal Children’s Health Insurance Program.


    Advocates for children said they were saddened by the findings but not surprised.


    “We know from studies of adults that lack of insurance contributes to worse outcomes, and this study provides evidence that there are similar consequences for children,” said Alison Buist, director of child health at the Children’s Defense Fund, a nonprofit advocacy organization. “If you wait until a child gets care at a hospital, you have missed an opportunity to get them the types of screening and preventive services that prevent them from getting to that level of severity to begin with.”

    The most common reasons for children being hospitalized were complications from birth, pneumonia and asthma. The study found that the reasons did not differ depending on insurance status.

    Earlier studies have found that uninsured children are more likely than insured children to have unmet medical needs, like untreated asthma or diabetes, and are more likely to go for two years without seeing a doctor.

    Following a recent expansion, 14 million children will be covered by the CHIP program by 2013, according to the Congressional Budget Office. Advocates for children are concerned that efforts to overhaul the health care system may actually reverse the progress made toward covering more children if CHIP is phased out and many families remain unable to afford health insurance.

    “You can’t just dump 14 million vulnerable children into a new system without evidence that the benefits and the affordability provisions are better than they are now,” Dr. Buist said. “That’s not health reform.”


    SOURCE Harvard Gazette

    These 20 Stories Refute The Idea That People Don't Die From A Lack Of Health Care Access

    By: Morgan Brinlee

    During a town hall in Lewiston, Idaho, one of the state's Republican representatives claimed that "nobody dies because they don’t have access to health care" in comments that have garnered significant criticism from people around the country.

    While Idaho Rep. Raúl Labrador was heavily booed Friday for his comments by his constituents, social media users around the country have since been responding to Labrador with their own personal stories of loss in an effort to educate the legislature on the importance of having access to affordable health care.


    "No one wants anyone to die," Rep. Labrador told a woman who had interrupted him during a town hall at Lewis–Clark State College in Lewiston. The woman accused Labrador of "mandating people on Medicaid to accept dying" by supporting legislation that significantly slashes Medicaid funding. "That line is so indefensible," Rep. Labrador continued. "Nobody dies because they don't have access to health care."

    However, a 2009 study conducted by doctors at Harvard Medical School and published in the American Journal of Public Health concluded that a lack of health insurance led to nearly 45,000 deaths a year.

    Rep. Labrador later attempted to walk back his comment, acknowledging in a statement posted to his official Facebook page that his response hadn't been "very elegant."


    "I was responding to a false notion that the Republican health care plan will cause people to die in the streets, which I completely reject," he wrote, adding that Republican's American Health Care Act does not change the fact that "all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay."


    Labrador did not address the potential personal debt and bankruptcies that medical services can often lead to for those without insurance.


    Here's how 20 people have responded to Rep. Labrador's claim that "nobody dies because they don't have access to health care."