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Date: May 21, 2002
FOR IMMEDIATE RELEASE
UNINSURED ADULTS MORE LIKELY TO DIE PREMATURELY
WASHINGTON -- Americans without health insurance are more likely to
have poorer health and die prematurely than those with insurance, says
a
new report from the National Academies' Institute of Medicine. Uninsured
patients with colon or breast cancer face up to a 50 percent greater
chance of dying than patients with private coverage. Uninsured victims
of
trauma also are more likely to die from their injuries. Being uninsured
for
even a year appears to diminish a person's general health.
"Because we don't see many people dying in the streets in this country,
we assume that the uninsured manage to get the care they need, but the
evidence refutes that assumption," said Mary Sue Coleman, co-chair of
the committee that wrote the report, and president, Iowa Health System
and University of Iowa, Iowa City. "The fact is that the quality and length
of
life are distinctly different for insured and uninsured populations."
The committee examined the consequences of being uninsured for people
suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney
disease, mental illness, traumatic injuries, and heart attacks. It focused
on the roughly 30 million -- one in seven -- working-age Americans without
health insurance. This group does not include the population over 65 that
is covered by Medicare or the nearly 10 million children who are uninsured
in this country. A future report will look at how the lack of health insurance
affects children and pregnant women.
Adults with public coverage, such as Medicaid, are a distinct group as
well since they tend to be in significantly worse health than those with
private insurance and even in somewhat worse health than those with no
insurance. Adults qualify for Medicaid because they are poor or have
already incurred unaffordable medical expenses. In addition, low-income
adults eligible for Medicaid often do not apply for it until they are sick.
Uninsured cancer patients die sooner than people with insurance do,
largely because of delayed diagnosis, the report says. The uninsured are
less likely to receive timely screening services such as mammograms,
Pap tests, and colon exams. By the time cancer is diagnosed in
uninsured patients, it is more likely to be at an advanced, often fatal,
stage. Likewise, uninsured patients tend to reach severe renal failure
before they begin kidney dialysis.
The longer diabetics go without health insurance, the greater the chance
they will experience uncontrolled blood-sugar levels, the report says.
Studies show that 25 percent of adult diabetics who were uninsured for
a
year or more went without a checkup for two years, compared to 5 percent
of diabetics with insurance. Uninsured diabetics also are less likely to
receive regular foot and eye exams, which can help prevent blindness and
amputations.
Uninsured adults with hypertension or high cholesterol are less likely
to
monitor their blood pressure or stay on drug therapy -- if they are fortunate
enough to be screened at all, the report says. Patients admitted to
emergency rooms with severe uncontrolled hypertension are more likely to
be uninsured.
Uninsured adults with HIV infection or AIDS are less likely to receive
the
highly effective "drug cocktails" that have become the standard treatment
in the past five years, the report says. And when they do get the newer
drug therapies, their wait to receive treatment has been an average of
four
months longer than that of patients with private insurance. Providing health
insurance to HIV and AIDS patients has been shown to significantly
reduce death rates.
"It wasn't difficult for us to conclude that if the uninsured became insured
on a continuous basis, their health would improve and they would live
longer," said committee co-chair Arthur Kellermann, professor and chair,
department of emergency medicine, and director, Center for Injury Control,
Emory University School of Medicine, Atlanta.
Mentally ill patients with insurance that covers their treatment are more
likely to receive appropriate care than those with no insurance, the report
says. Even when health insurance does not specifically cover
mental-health expenses, just having it increases the likelihood that
someone with depression or anxiety will receive some care. People with
severe mental illnesses such as schizophrenia or bipolar disorder have
trouble keeping health insurance coverage after diagnosis because they
have difficulty holding down jobs. Until they gain public insurance
coverage, these patients face delays in receiving appropriate services.
To see how uninsured patients fare in a hospital setting, the committee
focused on two conditions for which most people are treated regardless
of
whether they are insured: traumatic injuries and heart attacks. It found
that uninsured persons with traumatic injuries are less likely to be
admitted to the hospital, receive fewer services if they are, and are more
likely to die than insured victims. One statewide study of car crash victims
discovered that uninsured victims had a 37 percent higher mortality rate.
Another statewide study found that although uninsured trauma patients
were just as likely to be placed in intensive care, they were less likely
to
be operated on or to receive physical therapy.
Research also shows that uninsured patients hospitalized for a heart
attack have a greater risk of dying during their hospital stay or shortly
thereafter than patients with private insurance. They also are less likely
to
go to a hospital that performs angiography or other catheterization
techniques, and even if they do, they are less likely to receive such
sophisticated procedures.
Studies that have monitored the health of people who had no insurance or
temporarily lost it for a period of one to four years show that a person's
overall well-being suffers during the time they lack coverage. The decline
in
health caused by a lack or loss of coverage is most profound for adults
between 55 and 65 years old, the report says. Symptoms of worsening
health might include high blood pressure, greater difficulty climbing stairs
or walking, or a decline in general self-perceived wellness.
Health insurance strategies that target the entire uninsured population
would be more likely to produce greater health benefits and increase life
expectancy than "rescue" programs aimed only at the seriously ill, the
committee said.
Being uninsured magnifies the health risks for chronically sick and
mentally ill patients, as well as for groups that are already at greater
risk
of poor health, such as racial and ethnic minorities and adults with low
incomes, the committee said. It added that increasing health insurance
coverage would reduce some, but not all, of the disparities in health care
experienced by racial and ethnic minorities.
The committee noted that the research literature on which it based its
findings probably understates the differences in health outcomes between
insured and uninsured adults. The studies cannot account for the
experiences of those who do not seek treatment, and uninsured adults are
less likely to seek treatment.
The report is the second of six that will constitute an extensive review
of
research intended to paint an accurate portrait of who lacks health
insurance and why, along with the personal, social, and economic
consequences. Rather than add to the many policy recommendations
already on the table, the study is designed to lay the groundwork for a
more informed and productive public debate about health care coverage.
The committee's final report, however, will identify promising strategies
for
addressing the problems of uninsurance in the United States.
The study is being sponsored by the Robert Wood Johnson Foundation.
The Institute of Medicine is a private, nonprofit institution that provides
health policy advice under a congressional charter granted to the National
Academy of Sciences. A committee roster follows.
Copies of CARE WITHOUT COVERAGE: TOO LITTLE, TOO LATE are
available from the National Academy Press; tel. (202) 334-3313 or
1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU.
The cost of
the report is $27.00 (prepaid) plus shipping charges of $4.50 for the first
copy and $.95 for each additional copy. Reporters may obtain a copy from
the Office of News and Public Information.
INSTITUTE OF MEDICINE
Board on Health Care Services
COMMITTEE ON THE CONSEQUENCES OF UNINSURANCE
MARY SUE COLEMAN, PH.D.*
(CO-CHAIR)
President
Iowa Health System and University of Iowa
Iowa City
ARTHUR L. KELLERMANN, M.D., M.P.H. * (CO-CHAIR)
Professor and Chairman
Department of Emergency Medicine, and
Director, Center for Injury Control
Rollins School of Public Health
Emory University School of Medicine
Atlanta
RONALD M. ANDERSEN, PH.D. *
Fred W. and Pamela K. Wasserman Professor of Health Services and
Chair
Department of Health Services, and
Professor of Sociology
School of Public Health
University of California
Los Angeles
JOHN Z. AYANIAN, M.D., M.P.P.
Associate Professor of Medicine and Health Care Policy
Department of Health Care Policy
Harvard Medical School
Boston
ROBERT J. BLENDON, M.B.A., SC.D. *
Professor of Health Policy and Political Analysis
Department of Health Policy and Management
Harvard School of Public Health and John F. Kennedy School of
Government
Boston
SHEILA P. DAVIS, B.S.N., M.S.N., PH.D.
Associate Professor
Department of Adult Health
School of Nursing
University of Mississippi Medical Center
Jackson
GEORGE C. EADS, PH.D.
Vice President and Director
Charles River Associates
Washington, D.C.
SANDRA R. HERNÁNDEZ, M.D.
Chief Executive Officer
San Francisco Foundation
San Francisco
WILLARD G. MANNING, PH.D. *
Professor
Department of Health Studies
Pritzker School of Medicine and
Harris School of Public Policy
University of Chicago
Chicago
JAMES J. MONGAN, M.D. *
President
Massachusetts General Hospital
Boston
CHRISTOPHER QUERAM, M.A.
Chief Executive Officer
Employer Health Care Alliance Cooperative
Madison, Wis.
SHOSHANNA SOFAER, DR.P.H.
Robert P. Luciano Professor of Health Care Policy
School of Public Affairs
Baruch College
New York City
STEPHEN J. TREJO, PH.D.
Associate Professor of Economics
Department of Economics
University of Texas
Austin
REED V. TUCKSON, M.D. *
Senior Vice President
Consumer Health and Medical Care Advancement
UnitedHealth Group
Minnetonka, Minn.
EDWARD H. WAGNER, M.D., M.P.H., F.A.C.P.
Director
W.A. MacColl Institute for Healthcare Innovation
Center for Health Studies
Group Health Cooperative of Puget Sound
Seattle
LAWRENCE WALLACK, DR.P.H.
Professor of Public Health and Director
School of Community Health
College of Urban and Public Affairs
Portland State University
Portland, Ore.
INSTITUTE STAFF
WILHELMINE MILLER, M.S., PH.D.
Study Co-Director
DIANNE MILLER WOLMAN, M.G.A.
Study Co-Director
* Member, Institute of Medicine