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June 10th, 2010
12:05 AM ET

Uninsured more likely to die during hospital stay, study finds

By Sabriya Rice
CNN Medical Producer

When uninsured patients are treated in the hospital for heart attack, stroke and pneumonia, they are more likely to die from the conditions during their hospital stay, a new study finds.

Researchers from Harvard Medical School and Brigham and Women’s Hospital in Massachusetts investigated the impact of insurance coverage on hospital care, by analyzing the discharge data of more than 150 thousand adults between ages 18 and 64. The study, published today in the Journal of Hospital Medicine, found that compared with hospitalized patients who have insurance, uninsured patients were 52 percent more likely to die in the hospital after a heart attack and 49 percent more likely to die in the hospital after a stroke. Patients on Medicaid were 21 percent more likely to die in the hospital while receiving treatment for pneumonia.

The study authors say these findings are “concerning,” especially considering vast improvements over the past few decades in treating these common conditions.

So what are the reasons for the disparities? Though this study could not address that particular question, in the study's conclusion Dr. Omar Hasan, the lead author, cites three main schools of thought he says could help explain the findings:

1) The uninsured are more likely to delay care
Recent studies, including one from Saint Luke’s Mid America Heart Institute, have shown that people without insurance are more likely to delay seeking care for heart attacks, stroke and pneumonia because of concerns about the cost of treatment. As a result, “patients let their disease progress to the point where they were sicker by the time they got to the hospital,” Hasan explains.

2) Hospitals avoid doing high-cost procedures on the uninsured
Studies from health disparity researchers at American Thoracic Society, for example, highlight how uninsured patients are less likely to receive lifesaving procedures such as pulmonary artery catheterizations when they are in the hospital. The researchers at Harvard say findings like these are a big part of the problem. "If every patient who walks into the hospital gets the care they need based on the best available evidence about making decisions, you should not have a gap at all," says Hasan, who is also a fellow at the Institute for Healthcare Improvement.

3) Possibility of substandard care
In their analysis, the Harvard report cites studies, including a comparison of uninsured and privately insured patients which concluded that the uninsured were at greater risk for receiving substandard care and that there are differences in the way uninsured patients are managed in the hospital.

As health care reform is implemented in the U.S., Hasan encourages policy makers to take these disparities into consideration as they revamp legislation. "One of the pillars of providing high quality health care is that there's equity across all populations," he says.

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soundoff (15 Responses)
  1. Sherri

    When they raised the rates to my insurance at my employment, I couldn't afford to have insurance. The day after my insurance was done, I had my first TIA symptom, they said nothing was wrong with my neck but yet after reading the medical report they noted the spasm. I have lost total feeling in my face for days at a time. They ran some tests, but they wont run all and cycle you out to a doctor you have to pay out of pocket, so every day I deal with headaches and pains that sometimes are unbareable. I wish they had one doctor that would actually volunteer his time to figure out what is going on. It's sad I go to school full time and work and raise my son without welfare and I cannot get proper medical insurance. I agree, I was treated horribly at the one hospital for not having insurance. That will be interesting when I do my clinicals there probably run into the same people.

    June 10, 2010 at 01:36 | Report abuse | Reply
  2. 2245

    This is terrible! I know it's not a solution for insurance for hospital related issues but, for the everyday we use theamericanreliefcard.com It's only 29.95 per month and we have a physician 24/7 via phone. No copay and they'll even call in your prescription. Plus I'd rather deal with a doctor via phone vs waiting in a room with tons of people and taking time off from work.

    June 10, 2010 at 07:36 | Report abuse | Reply
  3. Hannah Trimble

    Patients present with nutrition issues, unhealthy home environment, substandard cleaning standards at home, delayed decisions for medical care and fears of discharge to return home to that situation that they were able to leave.

    June 10, 2010 at 14:32 | Report abuse | Reply
  4. N.

    Sherri – So.... what "school of thought" do you THINK you fall into above?

    Maybe I'm wrong., but from the tone of your comment, it sounds like you think that the medical community either is giving you substandard care or not willing to run high-cost tests on you. But – in reality – you fall into the first school – you are more likely to delay care.

    "They ran some tests, but they won't run all and cycle you out to a doctor you have to pay out of pocket, so every day I deal with headaches and pains that sometimes are unbearable." Again, maybe I'm wrong – but I have a hard time believing that – if you were able/willing to pay – they would not run those tests. "Cycle you out to a doctor you have to pay out of pocket...." – ummmm, that's what happens when you don't have insurance....

    "I wish they had one doctor that would actually volunteer his time...." Why? Doctors – we are told – need to get paid. Before your insurance company paid. Now you have to pay, and you're making a decision to delay/not get treatment because of the cost.

    So in reality, you are delaying care because you can't afford it. So – when your warning stroke becomes a stroke and you go into the hospital, the chances are much greater that you are going to die from that stroke, rather than if you (or your insurance) had paid for the tests, and the doctor, and the meds and either avoided the hospital altogether, or lessened the impact of the stroke.

    I feel for you, but it's important to realize that the "economic" choices we make as healthcare consumers have real impacts on our health and lives.

    June 10, 2010 at 15:31 | Report abuse | Reply
    • Karla Whitmore

      I was taken to the ER after my first grand mal. I had not delayed seeing a doctor. The grand mal seizure was a complete surprise as I did not (to my knowledge) have epilepsy. They treated me like an inconvenient chore. Did NOT run all the tests normally run on people who present with first seizures. All they did was pump me full of phenytoin, hand me a prescription, and point me to the bus stop. Two hours after having my first grand mal, I was walking (stumbling – and leaning on my husband), waiting on buses, and riding in a dream-like state as I was still recovering. I have since learned that those who are insured are usually given three different tests and kept overnight. The least amount of time a person who was insured (epilepsy forums) spent in the hospital was 8 hours. In the time I was there, they barely said two words to my husband and while they diagnosed me with unspecified epilepsy and as having a generalized tonic clonic seizure, they did not tell me anything about what that might mean. They just told me to see their associated neurologist and kicked me out. It was horrifying. Since, I HAVE delayed medical treatment because I cannot afford it, but that does not explain the bad treatment both my husband and I received in the ER. Why in the HELL is it assumed that those with money and insurance are more deserving of health and life? It is WRONG. What is more, it is ILLEGAL to treat the uninsured differently than the insured. For anyone who lives in Tucson and doesn't have insurance: Don't go to St. Joseph's hospital. The caring Catholic hospital is a big joke. We're making payments on the ambulance bill. We're pursuing legal help for the hospital bill. I'm willing to pay for the doctor's time (all 10 min he spent on me) and the medicine they flooded me with, but a $6,000 bill for two hours of being treated like a piece of nothing? I don't think so. Had they treated me right, I would at least feel right about making payments on $25,000 for real testing and the chance to recover in a bed.

      July 18, 2012 at 13:19 | Report abuse |
  5. N.

    But sorry Sherri – that's not the real reason I came to post. It was to share this story....

    My brother had a sore throat for something on the order of 3 weeks. He had just changed insurance to basically be an HSA and a high deductible catastrophic plan. Since he knew he'd have to pay full price for the doctor's visit and any meds, he avoided going.

    When his face started to swell over one weekend, he decided it was probably time to go to the ER. They admitted him, pumped him full of antibiotics, and a few days later the swelling started to go down. His doctor told him he had severe strep throat and was probably about 12 hours from dieing. If he had just "delayed care" a little longer, he would be a statistic like the above – 50% more likely to die in hospital.

    To be sure – my brother and wife had a friend where the same thing happened and he did die. He waited to go to see a doctor until it was really bad, went to the ER, and they said he had the flu. Came back 6 hours later and said – this isn't the flu and died 12 hours after that.... I don't know the guys insurance status, and it sounds like two things at work here which didn't help each other – he waited, too long, and that was compounded by substandard care....

    June 10, 2010 at 15:40 | Report abuse | Reply
  6. Monica Soltes

    Completely tragic but completely true.

    The new symbol of wealth in America is to have health insurance.

    For those who cannot afford it or are disqualified due to preexisting conditions the prognosis is grim at best.

    In a free market society would it be fair to treat those who do not pay a monthly premium the same as one who economizes to cover their premium. It is a form of reverse discrimination.

    Know not the solution to this heartbreaking dilemna in our society.

    Know that out of compassion and humanity we must find a solution.

    June 10, 2010 at 16:19 | Report abuse | Reply
  7. dxp2718

    There is a fourth explanatory possibility they did not mention. It is possible that uninsured people are in general less healthy. This could be because they are stressed due to lack of insurance, are less likely to have steady work and thus insurance because the are unhealthy, or any number of other reasons.

    The only way to test this would be to do a study at an ER where patients are treated before their insurance information is collected. Only just before discharge would the doctors find out whether their patients were insured or not. If the real reason has to do with the uninsured being treated differently, then the rates should be the same for insured and uninsured when the doctors don't know which category their patients are in. If the disparity continues even while the doctors are kept in the dark about insurance while treating patients, then it'll be clear that some correlating factor is at fault.

    June 11, 2010 at 02:46 | Report abuse | Reply
  8. PD Norman

    Unfortunately when a person goes to the E.R. the first thing they perform is a lobotomy of your wallet. Insurance companies don’t deny the most needed treatments, it’s the hospital and doctors that deny treatment to those that can’t pay.

    Last year I took my two year old daughter to a children’s hospital ER, she was having difficulty breathing. They asked how was I going to pay for the visit and told them I’ll pay through my insurance and handed them my insurance card. My insurance card is both the charge card to my HSA and my insurance card information. Well the young lady must have been confused by the VISA logo and thought I was self insuring myself through a credit card. She and the rest of the staff were not the most hospitable people around and she kept talking over me (I didn’t mind – I thought they may have had a long day).

    After 20 minutes waiting in almost empty waiting area, I inquired about the status of seeing someone and asked if they were done making a copy of my insurance card. When she realized that my card was an insurance card and not a credit card, that’s when things started speeding up and the staff started acting friendlier. We were called a few minutes later and saw a doctor.

    My daughter was delayed care because the hospital thought she was uninsured. I can’t imagine what would occur if someone came to the ER unconscious and without a wallet – will the staff delay treatment till the can secure an insurance card?

    Lobotomy of the wallet.

    June 11, 2010 at 10:45 | Report abuse | Reply
  9. Rick McDaniel

    Simple. No one is going to spend money on someone who doesn't have insurance. Not even public hospitals.

    June 11, 2010 at 12:25 | Report abuse | Reply
  10. M

    PDNorman–Actually the federal EMTALA law requires that ERs provide a medical screening exam and stabilizing treatment to anyone who shows up requesting medical care for an emergency medical condition. ERs are well aware of that fact and the ER you took your daughter to was required to evaluate her whether or not you gave them a VISA card or your insurance card. Is it possible that you simply encountered a tired, stressed triage clerk and you misinterpreted things?

    On another note, think for a bit about how doctors and hospitals are supposed to stay in business if they continually don't get paid for work that they do? Is there any other type of business in America where federal law dictates that you work for free? How is this a viable long term business model? You can say all you want that insurance companies don't deny care, but is it the doctors' and hospitals' responsibility to work for you for free if you are uninsured? And of course still be financially liable for poor outcomes, too.

    June 11, 2010 at 14:41 | Report abuse | Reply
  11. Peyton Rivera

    heart attack can be prevented by taking CoQ10 and also Fish Oils~`-

    September 8, 2010 at 15:33 | Report abuse | Reply
  12. UPVC Windows

    heart attack is very common these days, it is because of a high fat diet and lack of exercise '"-

    December 16, 2010 at 02:38 | Report abuse | Reply
  13. courtney

    IWhy should people be punished for not having insurance? I suppose you believe that people with pre exisiting conditions should also be denied care if they care unable to afford private insurer rates that can be more than $1000 a month. The healh care indistry is run like a corporation. It does not exisit to help people, it exists to make money. People who are insured, and those who are not deserve the same standard of treatment. I don't know how some of these Dr's sleep at night knowing did not do all they could do to save someones life based upon the fact they they are unable to afford insurance. If you are only going into the health care profession to make money, you should definitly seek another career. I want my Dr to be focused on curing me not how much money I am going to be putting into his pocket. And the fact that you are looking at a hospital as a business model, that says it all right there. You and the rest of the horrid CEO's that help people die every day. It's sad that our country treats it's citizens this way, anything for the almighty dollar I suppose.

    January 18, 2011 at 12:39 | Report abuse | Reply
  14. WillieZ

    Courtney apparently you dont understand adverse selection. And your paragraph further illustrates your ignorance. I suggest you disembark from the ObaManure Express.

    January 18, 2011 at 12:49 | Report abuse | Reply

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