Atlanta Journal Constitution
THURSDAY, Sept. 17
If you doubt that lack of health insurance can have deadly consequences, consider these new findings: Americans without health insurance are 40 percent more likely to die than those with private insurance.
As many as 44,789 Americans of working age die each year because they lack health insurance, more than the number who die annually from kidney disease.
The study comes at a pivotal moment in history, as Congress considers legislation to expand health insurance coverage. The findings imply that lack of health insurance isn’t just a policy issue, it’s a significant health risk.
Being uninsured is associated with a risk of death, “and it turns out to be an elevated risk,” said Dr. Andrew P. Wilper, lead author of the study and an instructor at the University of Washington School of Medicine in Seattle.
The study appeared Thursday in the online edition of the American Journal of Public Health.
Wilper, formerly of Harvard Medical School in Boston, and his colleagues used data from the Third National Health and Nutrition Examination Survey, conducted between 1988 and 1994. Their analysis included people aged 17 to 64.
The research replicates a 1993 Institute of Medicine (IOM) study, which found a 25 percent higher death risk among the uninsured compared with privately insured adults.
Due to the margin of error in each study, Wilper can’t say whether the risk of death has increased over time. However, if there is an increased risk, he suspects it’s because treatments for insured Americans have gotten much better for certain conditions, such as hypertension, diabetes and coronary heart disease.
The study also corroborates certain predictors of mortality among the uninsured. The death risk is higher for men than women, smokers than non-smokers, heavier drinkers and people who are older, for example.
“The things that we would expect to predict death seem to,” said Wilper. “Nonetheless, even after controlling for all those things, we find this elevated risk for death among those without insurance.”
Not everyone agreed with the new findings, however. In a statement released Thursday, the National Center for Policy Analysis, which opposes nationalized health care, called the Harvard research “flawed.”
“The findings in this research are based on faulty methodology and the death risk is significantly overstated,” NCPA President John C. Goodman said. “The subjects were interviewed only once and the study tries to link their insurance status at that time to mortality a decade later. Yet over the period, the authors have no idea whether subjects were insured or uninsured, what kind of medical care they received, or even cause of death.”
But another expert supported the research. Lucien Wulsin, director of the Santa Monica, Calif.-based Insure the Uninsured Project, said that while the study does not examine how or why the uninsured died, it seems to substantiate what is already known about the lack of access to health care services.
“I saw it as very much validating the earlier [IOM] study, that being without health insurance means that you have a greater likelihood of mortality because you don’t get the care when you don’t have the health insurance until ‘too-little too-late,'” Wulsin said.
Wilper said the IOM identifies three factors that influence health outcomes: not getting care when needed, not having a regular source of care, and not getting continuity of coverage.
“If you have an illness that may have dire consequences if it’s untreated, such as hypertension or coronary artery disease, and you can’t get in to see the doctor, you’re more likely to have some serious outcome from that untreated illness,” he said.
California led the nation in excess deaths from lack of health insurance — with 5,302 deaths in 2005.
“Safety net” funding to support health care services for California’s poor and uninsured has not kept up with the growth in the ranks of the uninsured and the escalating cost of medical care, Wulsin observed. He suspects the same factors are playing out nationwide.
So what’s the solution? Policymakers should cover as many people as possible, Wulsin said, and they should focus on primary care and preventive services so that people don’t delay care and end up in the emergency department “with conditions that are hard to deal with at that point.”