Study: Uninsured Don't Get Needed Health Care

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Study: Uninsured Don't Get Needed Health Care

Delayed Diagnoses, Premature Deaths Result

The lack of health insurance in America leads to delayed diagnoses,

life-threatening complications and, ultimately, 18,000 premature deaths each

year, according to a report released yesterday by the Institute of Medicine.

In the first comprehensive study of the medical consequences of going

without insurance, researchers commissioned by the National Academy of

Sciences found that " being uninsured for even a year appears to diminish a

person's general health. "

Despite the popular belief that uninsured Americans simply walk into the

hospital for medical services, the vast majority go without health care

until an illness becomes too serious to ignore.

" Because we don't see many people dying in the streets in this country, we

assume that the uninsured manage to get the care they need, but the evidence

refutes that assumption, " said Sue , president of the Iowa

Health System and co-chair of the committee that wrote the report. " The fact

is that the quality and length of life are distinctly different for insured

and uninsured populations. "

Many of the 30 million working Americans without insurance belatedly

discover serious illnesses such as cancer, diabetes, hypertension and HIV.

Others may go their entire lives without receiving treatment for a mental

illness, high cholesterol, arthritis or asthma, the authors found.

" It is very important folk have access to health care early before they are

ill and that they have access to a full range of basic services, " said

committee member Tuckson, a senior vice president at United Health

Group.

After a detailed analysis of 130 studies on the uninsured, the group

estimated that a lack of insurance translates annually into 360 to 600

premature breast cancer deaths, 1,200 to 1,400 deaths among HIV-infected

adults and 1,400 premature deaths due to undertreated hypertension.

" This is a major American problem, " said Tuckson, who specializes in

consumer health. " It is a tragedy of numbers. "

The central message of the report and its authors is that prevention and

early diagnosis have an enormous impact on mortality, quality of life and

even costs.

In the case of diabetes, early detection enables patients to monitor

blood-sugar levels and get regular foot and eye exams. The report found that

25 percent of uninsured diabetics went without a checkup for two years,

compared with 5 percent for those with insurance.

Hypertension and high cholesterol often can be controlled with medication

and diet. But lacking insurance, those patients " have diminished access to

care, are less likely to be screened, are less likely to take prescription

medication if diagnosed, and experience worse health, " the report said.

Because the uninsured are less likely to receive common cancer screening

tests such as mammograms, Pap smears and colon exams, they die sooner than

people with insurance. " The problem of later diagnosis and higher mortality

among uninsured women with breast cancer, for example, cannot be solved by

insuring women once the disease is diagnosed, " the authors note.

Even when a person without insurance gets to a hospital, that patient is

less likely to be admitted and more likely to receive fewer services.

" Often one of the first pieces of information obtained " in the emergency

room is insurance status, said committee member Ayanian, a health

policy expert at Harvard Medical School.

One study found that uninsured patients with cardiovascular trouble are less

likely to be admitted to a hospital that performs angiography; another found

that the risk of death after arriving at the hospital was 37 percent higher

among the uninsured.

More significantly, Ayanian said: " Emergency rooms are not equipped to

diagnose people early or treat chronic illness. "

Conversely, a person with health coverage is more likely to develop a

relationship with a physician, undergo periodic screening and be better

educated about healthy lifestyles. People with insurance are also more

inclined to seek services that are not covered.

Of the 40 million Americans without insurance, about 30 million are adults

ages 18 to 65. Nearly 85 percent of uninsured adults work or live in

families in which someone works.

Forgoing health insurance " is not a cavalier decision, " said. " Most

people don't have the resources " to pay premiums and copayments -- if an

employer offers some type of coverage.

Although the report focused on medical outcomes, the committee suggested

other, less tangible benefits come with health insurance.

" Financial security and stability, peace of mind, alleviation of pain and

suffering, improved physical function, disabilities avoided or delayed, and

gains in life expectancy " are among the advantages, they concluded. " For

many of the 40 million uninsured Americans, these benefits remain out of

reach. "

http://www.washingtonpost.com/wp-dyn/articles/A52828-2002May21.html