Uninsured Twice as Likely to Die in ER

New Study on Patients with Traumatic Injuries Surprises Doctors and Health Experts who Believed ER Care was Equitable

(AP)  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."

[Liberalady]

Oh. And I'd like to see one death certificate with Cause Of Death: Uninsured written on it but I am betting we will be able to see more than we want to see with Cause Of Death: Obamacare written on it.

[Liberalady]

Having been involved with ER care for years I can honestly say that there is zero truth in that the unisured do not get the same quality care as the insured. If the death radio is tilted against the unisured it is because of the lifestyle most of them chose to engage into long before they present to the ER for their calimity, thus compromising their health in general. Their choice.

Did the study also show that the lawsuit ratio is also tilted? More lawsuits filed by unisured than by the insured. Funny how this so-called "study" shows up about now. How about a study done showing how many uninsured people sneak out or leave the ER when they are told they are not getting the drugs-of-choice they name. "Patient requests morphine. States it is the only thing that will stop her diarrhea."

[32mm]

"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."

Michelle Obama might know something about this.....

[Void_Master]

From the story: "President Barack Obama, who took office in January, campaigned on a promise of offering affordable health care to all Americans.
"

***

Then *offer* it and stop trying to cram it down our throats. We're not going to pay for what we don't want.

[apuan777]

This study is so flawed I can't even think where to start. After reading this and thinking for two seconds, I came up with a few arguments why this study is weak.

1. What is the control group in this study? Were healthy people analyzed before they were brought to the ER and then studied during their stay and then after their stay?
2. What was the prior health of the people studied prior to them entering the ER? The patients prior health history would have a direct effect on their ability to heal. The study assumed younger patients would be healthy.
3. The numbers state that 690,000 patients were studied, but on analysis the document doesn't show exact figures for each patient group, rather it shows percentages. Was it 50/50 insured vs. uninsured or do more uninsured people enter the ER with injuries?
4. How do you compare injuries? If the injury is gunshot, was the study broken down to compare apples to apples...i.e was something categorized as gunshot or gunshot to lung with puncture. The severity of the subgroups of injuries would have a direct impact on the death.
5. Why were DOA not counted in the study? Does care not begin at the scene? What does this study consider the starting point of patient care? What about the length of time to hospital or the part of the country the person lived in? You could easily make an argument that rural areas emergency services are spread out making emergency care more difficult.

I could keep going but this is a waste of time...this study has very little credibility...Although this could be the reality, this study is not extensive enough or detailed enough to be scientific. Harvard? Seriously?

[doutless]

That sounds like someone desperately looking for a flaw in a report they don't agree with. They may have answers to all your points. Do you have any answers to the questions you posed? If not, how can you attack them for their "poor" work when you have done none to support your view? SWAG....even without control groups or prior study, I'll bet you are against healthcare reform. (you probably know SWAG means Scientific Wild A** Guess, but I thought I should mention it.) By the way, about point 5, if you catch fire and someone throws water on you, has your medical care officially begun? On the other hand, I thought Xamkr had a excellent point.

[retm-w]

It will be worse when you dump 50 million more people into an understaffed system. Emergency rooms are overloaded now with people using them for doctors offices, and even with insurance it won't change because it's more convenient to use the emergency room.

[apuan777]

Clearly, some type of healthcare reform is needed in America. Using an ER as a doctor's office is exhausting resources at an alarming rate. There are no views or politics in my questioning this study. The idea of publishing a study, saying it is fact, and then spreading that idea to the general public is misleading. Whether or not I agree with health care reform has no bearing on this studies lack attention to detail. As to point 5, my point would be that patients may receive varying care prior to entering the ER. You would have to rate or test each technician on the scenes of these incidents to ensure they have equal skills. My overall point was not to start a debate, but to dispute the scientific or medical accuracy of this study. Harvard is a renowned institution and a big headline like "Uninsured Twice as Likely to Die in ER" would likely convince someone at face value.

[retm-w]

apuan777 I don't disagree with you, nor do I think it's political. You are 100% correct about first responders EMT vs Paramedic, how they are equipped, distance to the hospital, life flight vs ground transportation. And I'm sure there are many more.

[gramto8]

by retm-w November 16, 2009 7:46 PM EST
It will be worse when you dump 50 million more people into an understaffed system. Emergency rooms are overloaded now with people using them for doctors offices, and even with insurance it won't change because it's more convenient to use the emergency room.
_______________________________________________________________
The people using ERs as doctors' offices are usually the uninsured who cannot get a doctor's office to accept them as a patient. Therefore, in order to see a doctor of ANY sort, they must resort to using an ER as their primary care facility. Fixing the problem by making sure everyone has insurance will take those uninsured OUT of the ERs and allow them to be seen in doctors' offices instead. It will also allow them to begin having preventative care rather than just reactionary care.

[Xamkr]

The uninsured have the same survival rate until they realize the price of their ER visit is the same as buying a car.

[smoknmirrors]

So the RNC now has a Die Quickly and Get a New Car plan to rival the 72 virgins of Radical Islam?