Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality
By Stan Dorn
Urban Institute
January 2008
The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. This paper focuses on just one aspect of this harm–namely, greater risk of death–and seeks to illustrate its general order of magnitude.
In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.
More broadly, these estimates should be viewed as reasonable indicators of the general magnitude of excess mortality that results from lack of insurance, not as precise “body counts.” The true number of deaths resulting from uninsurance may be somewhat higher or lower than the estimates in this paper, but that number is surely significant.
http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf
Comment:
By Don McCanne, MD
More numbers…
Is this what the health care reform movement is all about?
Do we just keep tallying casualties? Body counts that aren’t real body counts? Policy studies from statistical tables that are devoid of any references to real human beings that we knew and loved?
Well, yes. This is work that has to be done to better understand the flaws in our health care system. The Institute of Medicine and the Urban Institute are to be commended for quantifying the consequences of lack of insurance in terms of the lethality of that health care financing deficiency. We now know that the 18,000 deaths per year due to lack of insurance has become 22,000 – a new number for us to use in our advocacy work.
But what are we doing with these studies? Since the IOM study was designed to isolate the single factor of uninsurance as a cause of mortality, it is clear that these lives would not have been lost had the individuals been insured. But is that true? Our response has been to attempt to cover more individuals by expanding the use of underinsurance, even though other studies are now showing that underinsurance is resulting in many of the same adverse outcomes as uninsurance. So simply being insured is no longer enough.
So where is the momentum on reform currently headed? State efforts and the proposals of leading candidates for president would have us all covered by individual private health plans, even though premiums for comprehensive plans are no longer affordable for average-income individuals. But instead of supporting financing systems that would provide comprehensive coverage for everyone (i.e., single payer), the policy/political community is supporting the shift to affordable private plans. The policy challenge has been to design underinsurance plans that are still comprehensive enough to avoid adverse outcomes because of financial barriers to care. It is a challenge they cannot meet. In order to make the premiums affordable for average-income individuals, the plans must be stripped of their function of removing financial barriers to care.
Do we really have to go through another decade or two of sterile examination of the statistical tables to calculate the mortality rates of the consequences of uninsurance and now underinsurance? Will the body counts that aren’t real body counts because they’re devoid of any references to real human beings provide us with any more motivation for honest reform? The numbers will be much larger, but will that really induce change?
Forgive me for being personal for a moment, but my current career as a full-time volunteer activist in the health care reform movement has a basis in my prior career. For over three decades, as a family physician, I saw real people who were uninsured and died merely because they didn’t have insurance. They died primarily because they delayed accessing the system because they didn’t have the money to pay for health care. I also saw many “underinsured” patients in the form of Medicaid, a program with such low reimbursement rates in California that it resulted in a lack of willing providers, with consequent impaired access and outcomes for the patients.
Was my practice about body counts? These were real people…
(I’m sorry. I can’t finish this…)