Study finds uninsured trauma patients much more likely to die in ER

"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 Associated Press reports. "The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable." The study was published in the November issue of the Archives of Surgery. Senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist, "favors health care reform and has frequently written about the inequities of the current system." The study could add fodder to the health care debate.

"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. … 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 study "analyzed data on nearly 690,000 U.S. patients from 2002 through 2006" (Johnson, 11/16).

Los Angeles Times: "The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility. Patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the researchers said. They also may be more passive with doctors and nurses because they don't interact with them as often. All of these factors could influence whether a trauma patient is able to recover" (Kaplan, 11/17).

Other outlets are reporting on ways to get health insurance.

The Salt Lake Tribune answers a reader's question on how long it would take before the uninsured would get coverage under health reform. While "most of the major provisions won't kick in for a few years, all the health reform proposals include some immediate reforms, such as the creation of a new high-risk insurance pool. The pool would serve the uninsured and people … who were denied because of a pre-existing condition. The House set aside $5 billion to create the program" (Canham, 11/16).

USA Today has a tip sheet for people to avoid becoming uninsured after their COBRA subsidy runs out. "Earlier this year, lawmakers agreed to temporarily subsidize health insurance for laid-off workers, providing a big discount for coverage until they got back to work. … Mindful of the 10% unemployment rate, some lawmakers have proposed extending the benefit, but that hasn't happened yet." Suggestions include waiting to drop COBRA until you have another insurance option lined up, even if it is expensive, and considering different health insurance options for various members of your family (Block, 11/17).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.