Community | November 16, 2009 | 28 comments

Uninsured ER patients twice as likely to die

source: http://www.msnbc.msn.com/id/33971846/ns/health-health_care/

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xiola

http://www.msnbc.msn.com/id/33971846/ns/health-health_care/

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 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."

Private hospitals more likely to transfer uninsured
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."

http://www.msnbc.msn.com/id/33971846/ns/health-health_care/
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28 comments // Uninsured ER patients twice as likely to die

  • jubal
  • J_Jammer
  • jac1992
    • 0
      jac1992  

    • The simple reason is, Insured people are mor elikely to have regular checkups to keep as healthy as they can , whereas the uninsured may not be able to afford to do that, and this shows that their health suffers

    • 3 years ago
  • J_Jammer
    • 0
      J_Jammer [removed]  

    • Ooh get that health care through fast...so it can start RIGHT AWAY in 5 years.

      Anyway it won't matter because even with the Bill there will still be people WITHOUT INSURANCE.

    • 3 years ago
  • CreditFigaro
  • J_Jammer
    • 0
      J_Jammer [removed]  
    • J_Jammer:

      It's like the retarded congress woman Shelia Jackson-Lee...who hails from Houston, TX...."We need to have that insurance NOW cause it would have saved children from dying of Swine Flu. Had we passed it they would have been saved instead of dying uninsured from this deadly virus." --- not actual quote. Mockquote.

    • 3 years ago
  • bashirdr
    • 0
      bashirdr  

    • Paratus, you make a good scientific point regarding the difference between correlation and causation. Do low income people who can't afford insurance also lead unhealthy lives (smoking, fast food)? If so, does that affect their ability to survive a traumatic accident?

      These are good questions, but a little common sense can also be useful. Hospitals are in business, and if they fold no one gets helped. They are incentivized to get as much money as they can from the insured and spend as little time as possible treating the uninsured.

      This study is not the silver bullet of the health care debate, but when you look at all the evidence as a whole, it is clear that the system needs to be changed so that the players - who are, I hope, by and large, good people - can be good people.

    • 3 years ago
  • Paratus
    • 0
      Paratus  
    • bashirdr:

      Eating bad food and generally leading unhealthy lives is not a mandate for reform of a healthcare system that, despite all your allegations, is not a failure. It may be expensive but it is not a failure. We have the best care in the world, bar none. Hospitals are in business. They have to be in order to keep the doors open. They have expenses just like everyone else. You cannot expect free treatment just because you are sick. Healthcare "reform" as proposed by the House will not change litigation against doctors or hospitals, will not allow purchase across state lines, will bring another layer of taxes on us and as the final insult, provide for fines and jail time for not signing up. This has nothing to do with providing a better healthcare system. It has to do with government control.

    • 3 years ago
  • bashirdr
    • 0
      bashirdr  
    • bashirdr:

      I think you misunderstood my first point, but from your reply I see that you misunderstand a great many things. Like the fact that any healthcare system which fails to provide care for a big chunk of its people is obviously a total failure. Reform (sans quotes) is exactly what we need. That means taxing the rich, who can afford to give a little more, and requiring everyone to obtain insurance, so everyone will be covered, which is what any citizen of a first world nation should expect.

      But you go and hide under your bed while the government takes control. That seems like the safest bet for you.

    • 3 years ago
  • 02
    • 0
      02  

    • Insurance is scam - they have inflated healthcare so that halrf of us can't afford it. All of them taking too much.
      I got a bill from an emergency room visit - where the charge for a ten cent pill was $100.

      When you charge $100 for a ten cent item, - thinking you're really making out by ripping someone off, - you destroy the value of every $100 bill in the country. Suddenly everybody has to charge more and more and more.

      The whole time the ten cent items are still worth no more than ten cents. It is just the money-base itself that is ruined - and everybody is running faster and faster on a tread-mill that doesn't feel good to anyone.

      In short, these kinds of abuses are criminal - in that they ruin the lives of many and hold down the potential of the whole country.

      Look at us now.

      You got to to deliver a buck's worth of goods - for a buck.

    • 3 years ago
  • Paratus
    • 0
      Paratus  

    • I have transported hundreds of people to the hospital. Never have I seen a difference in the quality of care determined by ability to pay. What a crock.
      I would look at lifestyle differences related to the two groups.

    • 3 years ago
  • arikata
    • 0
      arikata  
    • Paratus:

      While I am sure you do a very good job, you are not the entire health care system so it's hard to judge the whole.

      And while would life style differences have much to due with it, the study says that these were patiencts with similar injuries.

    • 3 years ago
  • CreditFigaro
    • 0
      CreditFigaro  
    • Paratus:

      Perhaps the inability to purchase healthy food? (veggies are more expensive than mcdonalds for some reason)

      The inability to see a doctor over time for preventative care, higher stress because of being low income, and low income people do more physically stressful work could all be contributory.

    • 3 years ago
  • jkudurog
    • 0
      jkudurog  

    • KSirys.... you have no idea what you are talking about. Stop making doctors millionaires???!!??? Last time I checked the average salary for a primary care physician was somewhere around 130,000 a year. He is also assuming a huge amount of debt in loans (250,000 by the time I'm done) along with a huge amount of responsibility for peoples lives. You may want to inform yourself before you speak. To make it sound like docs don't care about their patients is absurd... it's more complicated than you make it sound with your misinformation.

    • 3 years ago
  • KSirys
    • 0
      KSirys  
    • jkudurog:

      jkudurog, really? last time I checked and I've dated 2 not one but 2 doctors... both were making over $500k a year and their friends more... it's sad that you have all that debt, but you're one the few poor doctors out there with those debts. Not all doctors have debt like you and most are already making $280k + as soon as they are hired.

      So jkudurog, just because you live in area where doctors don't pay, it doesn't mean the country as a whole, goes through the same shitty problems you have.

      Not all doctors are bad and you're somewhat right, not all doctors are millionaires, but in the East, there are more rich and wealthy doctors, than any where else in the country.

      Check your facts before you speak as well, because you're misinformed, in debt and your "poor me" attitude is what is keeping you in the debt.

    • 3 years ago
  • JulianCommongold
    • 0
      JulianCommongold  

    • I dunno.

      I went to the ER with an ear infection 2 weeks ago. My ear canal was swollen shut and I had a fever for days that fluctuated up to 102.
      I was told it was close to going septic and it may have gone to my heart had I not gone in.
      Although I never was admitted to a room I stayed in triage for almost 30 hrs on a drip among other things until my fever went away.

      I was then sent home with a two week supply of cipro @ 500 mgs, amoxicillian @ 500 mgs, a steroid pack and 2 refills for vicadin @ 500 mgs.

      I am not insured.
      I know it was not "TRAUMATIC" injury but it could have been fatal non the less.

    • 3 years ago
  • arikata
    • 0
      arikata  
    • JulianCommongold:

      Well I'm glad this is the case for you but it certainly doesn't give an example of the health care system as a whole. I've seen the workings of the hospital of my city and I know I'm going to be in big trouble if I get injured.

    • 3 years ago
  • JulianCommongold
  • JulianCommongold
  • KSirys
  • arikata
    • 0
      arikata  

    • Well that's very scary...I'm a young college student with a few skeletal birth defects so insurance is simply not an option for me.

    • 3 years ago
  • wayseeker
    • 0
      wayseeker  
    • arikata:

      If the health care bill presented by the Democrats is passed you cannot be omitted from insurance because of your preexisting condition. Let's hope they can overcome the Republican's defiance of the public's well fare.

    • 3 years ago
  • arikata
    • 0
      arikata  
    • arikata:

      That would be wonderful. I lived in New Zealand for a few years, which is under a national health plan, and it worked very well. People need to just get their heads out of the ground and look around them. Our system clearly doesn't work.

    • 3 years ago
  • thecoyote23
    • 0
      thecoyote23  
    • arikata:

      Unless you get hurt when you are in college and can't afford to continue, can't get a job, and thus can't get insurance. Thanks Republicans for ruining our lives, or killing us....

    • 3 years ago
  • arikata
    • 0
      arikata  
    • arikata:

      Or you know, like I said the whole I was born with some spinal birth defects. They don't effect my life to much right now, but no insurance company will cover me with them, or if they do will charge a huge amount. And what about right now, if I get hit by a car today I'm screwed. We can't live in a system where our people are left unprotected until they're thirty.

    • 3 years ago
  • wayseeker
    • 0
      wayseeker  

    • Often people who don't have adequate insurance are released from the hospital sooner than people with insurance. Getting patients in and out of the hospital as fast as possible leads too inadequate and incomplete treatment. Doctors who fear they may not receive total payment may forgo necessary surgery on uninsured patients. Some emergency mental health clinics use the criteria that people, regardless of the severity of their condition, must be suicidal before being admitted too a hospital ward. This is their method of weeding out the uninsured. We must not continue to allow so many people too die and suffer because of these practices. We need health reform now.

    • 3 years ago
  • xiola
    • 0
      xiola  

    • Well, we certainly need some kind of reform. My husband and I are self-employed and work very hard toward the "American Dream", and we cannot afford insurance. No way. So now I know I better be extra-careful. Something's gotta give.

    • 3 years ago
  • KSirys
    • 0
      KSirys  

    • Another reason why the government needs to step in and get the health coverage package done ASAP, that way it can save lives and stop making doctors Millionaires!!

    • 3 years ago
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