Dying from Lack of Insurance

Dying from Lack of Insurance

September 24, 2009
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A new study from researchers with the Harvard Medical School found that 45,000 deaths a year can be attributed to the lack of health insurance. Our readers ask: Really? And, they want to know, isn’t this finding actually from the single-payer advocacy group Physicians for a National Health Program?

We’ll answer the latter first: The study was conducted by six researchers who were all with the Department of Medicine at Cambridge Health Alliance, which is affiliated with Harvard Medical School. It was published by the American Journal of Public Health, a peer-reviewed journal. Lead author Dr. Andrew P. Wilper is now with the University of Washington Medical School. As for PNHP, two of the authors have strong connections with the group: Dr. Steffie Woolhandler and Dr. David Himmelstein, a professor and associate professor of medicine, respectively, at Harvard Medical School, are co-founders of PNHP, a group of physicians that advocates for a single-payer health care system.

PNHP publicized the results of the study. Harvard, too, touted the research. Dr. Woolhandler told us that PNHP didn’t have anything to do with the study other than publicizing it after it was released. PNHP "didn’t fund it … didn’t have anything to do with analysis," she says.

The 45,000 deaths figure became the basis for an eye-catching billboard from the Health Care for America Education Fund, a group associated with Health Care for America NOW, a coalition of liberal and union groups backing health care overhaul efforts.

Now, on to the tough question: Is the 45,000 figure accurate? We can’t say for sure, but scores of other studies also conclude that persons without health insurance have a higher chance of dying prematurely than those with health insurance. A committee headed by Dr. John Z. Ayanian of the National Academies’ Institute of Medicine reviewed nearly 100 such studies released since 2002. And in March he summed up the findings for Congress this way:

Ayanian’s testimony to Congress, March 2009: Uninsured Americans frequently delay or forgo doctors’ visits, prescription medications, and other effective treatments, even when they have serious disease or life-threatening conditions. … Because uninsured adults seek health care less often than insured adults, they are often unaware of health problems such as high blood pressure, high cholesterol, or early-stage cancer. Uninsured adults are also much less likely to receive vaccinations, cancer screening services such as mammography and colonoscopy, and other effective preventive services.

The 45,000 estimate is at the high end of estimates, but earlier studies also have put the number of excess deaths from lack of insurance coverage in the thousands:

* A 1993 examination of 1971 through 1987 data on 25- to 74-year-olds from the National Health and Nutrition Examination Survey found a 25 percent higher risk of mortality for the uninsured compared with the insured, after adjusting for various factors, such as age, smoking, alcohol consumption, obesity, education and income. The study, by lead researcher Peter Franks, was published in the Journal of the American Medical Association.
* In 2002, the Institute of Medicine, basing its work on the Franks study and another examining Current Population Survey data, found that 18,000 people (age 25 to 64) died because they lacked health insurance in 2000. (Ayanian added in his testimony that for those with heart disease or cancer and without health insurance, the risk of death for the uninsured could be 40 percent to 50 percent higher.)
* In 2008, the Urban Institute updated the IOM numbers, using later Census Bureau estimates on the uninsured. It found that in 2006, the number who died because of a lack of insurance was 22,000. The Urban Institute also said that the IOM figure "may have underestimated the number of deaths" by trying to calculate different mortality-rate