US: Lack of insurance linked to thousands of child deaths

By Naomi Spencer
30 October 2009

Lack of health insurance may have caused or directly contributed to the deaths of nearly 17,000 children in the United States over the past two decades, a new study has found.

Research of the Johns Hopkins Children’s Center, published October 30 in the Journal of Public Health, indicates that uninsured children were far more likely to die in the hospital than those with insurance. The study took in over 23 million hospital records from 37 states from 1988 through 2005 and accounted for a number of factors. When researchers compared death rates by underlying illnesses, the uninsured seemed to have an increased risk of dying, regardless of their medical condition.

Johns Hopkins researchers cautioned that because the study considered only deaths during hospitalization, not deaths after discharge or children who might have died without ever being hospitalized, the death toll is likely a conservative estimate.

Fizan Abdullah, the lead author and a pediatric surgeon at Johns Hopkins, said in a press statement about the study, “If you are a child without insurance, if you’re seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next town who has insurance.”

The study revealed 104,520 patient deaths out of 22.2 million insured hospitalized children, a mortality rate of 0.47 percent. In comparison, out of 1.2 million uninsured children, 9,468 died in the hospital, a rate of 0.75 percent. In order to find out how many of these deaths would have been prevented by health insurance, researchers applied a statistical simulation to the uninsured group by projecting the expected number of insured patient deaths based on the severity of their medical conditions.

Among the uninsured, 3,535 more children died than was accountable by disease severity. After applying this rate of excess deaths to the total number of child hospitalizations in the US over the study period—117 million—researchers found there were more than 16,787 deaths among some 6 million uninsured children who were hospitalized.

Insured children were found to be charged more for treatment, which the Johns Hopkins Children’s Center noted was “most likely explained by the fact that uninsured children tend to present to the hospital at more advanced stages of their disease, which in turn gives doctors less chance for intervention and treatment, especially in terminal cases.”

Parents of uninsured children were also “more likely to seek treatment through the Emergency Room, rather than through a referral by a doctor,” the researchers noted, “likely markers of more advanced disease stage and/or delays in seeking medical attention.”

Some 7.3 million children in the US lack health insurance, a substantial segment of the estimated 47 million uninsured Americans. According to the Kaiser Family Foundation, the average cost of insuring a family is over $13,000—more than double the costs of a decade ago and far out of reach for most working class families.

At the same time that insurance and medical costs have spiked, budgets have been slashed for public health clinics, preventive care programs, and other services comprising the social safety net for the poor and uninsured.

The Johns Hopkins study follows a Harvard study on health insurance and adult mortality in the US, released last month, which found that nearly 45,000 deaths each year were associated with the absence of insurance among working-age Americans. This figure translates into an average of one death every 12 minutes.

Researchers arrived at this figure after a 13-year study of more than 9,000 people and accounting for a multitude of factors, including education, income, smoking, drinking, and obesity. After accounting for all of these factors, the uninsured group still had a 40 percent higher risk of death than those with insurance. Reflecting the enormous increase in medical costs over the past two decades, the report notes that in 1993, the uninsured were considered to have a 25 percent higher risk.

According to the Harvard study, “The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance.” The researchers add, “Despite widespread acknowledgement that enacting universal coverage would be life saving, doing so remains politically thorny.”

A supplemental study from the Harvard team, released October 20, suggested that uninsured people with chronic illnesses often go undiagnosed and undertreated. Based on medical data of some 16,000 non-elderly adults, researchers found that of those who were uninsured and suffering from diabetes, fully 46 percent did not know they had the disease. Fifty-two percent of uninsured patients were not aware of their high cholesterol conditions.

Researchers stressed that along with the dearth of care for the uninsured, the large underinsured population also confronted a lack of access due to unaffordably high co-payments and deductibles.

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