Uninsured more likely to die from trauma than patients
with insurance, study finds
Research by Dietrich Jehle, M.D., has
shown that trauma patients without insurance are more likely to die
of their injuries from auto accidents and gunshot wound than
privately insured patients with similar injuries.
Friday, June 11, 2010
Trauma patients without insurance are more likely to die of their
injuries from auto accidents and gunshot wounds than privately
insured patients with similar injuries, according to findings of an
analysis of 193,804 patients from 649 facilities conducted by
University Buffalo emergency medicine physicians.
In addition, the authors found that Medicaid patients who were
injured in motor vehicle accidents had a lower death rate than
those with private insurance, indicating that factors other than
the level of financial remuneration for medical services are
influencing trauma outcomes.
Patients covered by any of the insurance plans studied -- Medicaid,
Medicare, private and managed care organizations such as HMOs --
had better mortality rates for all injuries than persons without
insurance, the analysis showed.
Results of the study were presented June 4 at the 2010 Society for
Academic Emergency Medicine Annual Meeting in Phoenix, Ariz.
Dietrich Jehle, MD, UB professor of emergency medicine and first
author on the study, says these findings suggest that the causes of
this difference are many and probably are not based just on quality
of care.
"Generally we don't know a trauma patient's insurance status when
we treat them initially in the emergency department, which makes us
ask if there are differences in these populations other than the
delivery of care," says Jehle. "This finding was a little
surprising.
"Both race and insurance status are independent predictors of
mortality rates for trauma outcomes, and of the two, insurance
status, specifically lack of coverage, is the most significant," he
continues. "This is not unexpected, since uninsured adult patients
in general have a 25 percent greater morality rate than insured
adults for all medical conditions."
Lack of insurance could influence mortality in a number of ways,
notes Jehle. With no way to pay for care, persons may delay getting
treatment. Those without insurance frequently are from ethnic
groups who face language or literacy problems, and may be afraid to
go to a hospital.
Other factors could include differences in risk-taking behaviors.
Studies have shown a relationship between not wearing seat belts
and lack of health insurance, and that the uninsured are likely to
drive older, less safe vehicles.
In addition, says Jehle, people without insurance have poorer
health status in general, which would lessen their ability to
survive a traumatic injury, and they often are treated differently.
"Research shows that, for other than trauma injuries, the uninsured
may actually receive less aggressive treatment and fewer diagnostic
procedures," he says.
Universal health coverage could change these statistics, Jehle
says. "For instance, there would be no need for patients to delay
treatment with universal health coverage, and such coverage could
improve the overall health status of injury victims and increase
their survival rates."
The study data was extracted from the National Trauma Data Bank for
2001-05. The researchers concentrated on patients between the ages
of 18 and 30 to eliminate those more likely to have chronic health
conditions, leaving 191,666 patients in the analysis with complete
data, including 150,332 blunt trauma patients and 41,334
penetrating trauma patients.
Blunt trauma patients were most commonly in motor vehicle
accidents, with smaller subgroups of patients with falls or
assaults. The penetrating trauma patients included all gunshot
wounds, plus small subgroups of injuries from stabbings.
"If health care reform progresses," says Dietrich, "it would be
interesting to revisit these findings."
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Thanks to University at Buffalo for this article.
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