Study: Insurance Affects Mortality

Uninsured trauma victims were nearly twice as likely to die from injuries in a hospital than insured patients, according to a study conducted by Harvard Medical School and Brigham and Women’s Hospital in Boston.

Dr. Selwyn O. Rogers Jr. ’87, a professor of surgery at Harvard Medical School, said he did not expect to find the disparity.

“Our initial hypothesis was that because trauma is not something that people plan for, there would be no death disparity between those who were insured and uninsured,” he said. “So we were surprised to find that lack of insurance affected mortality.”

Researchers analyzed patients of similar age, race, sex, and injury severity treated in trauma centers nationwide from 2002 to 2006.

The mortality rate of uninsured victims was found to be 80 percent higher than the rate for insured individuals, though the authors said there was no evidence of conscious bias by doctors.

Ellen R. Meara, a professor of health care policy at Harvard Medical School who was not involved in the research, suggested there could be several explanations for the disparity.

“There could be structural differences that are at work here: the uninsured could go to different medical facilities or wait to seek medical care,” Meara said. “Doctors may order similar procedures, but make it more difficult for an uninsured patient to receive them. There are still factors worth exploring, but we continue to see evidence that the uninsured are receiving different care, less care.”

The Harvard researchers pointed to a 2007 study at the University of Rochester demonstrating that uninsured patients were less likely to receive consultations with doctors and tended to have shorter stays than insured patients.

Uninsured patients may also be less apt to tell physicians their health concerns or to be accompanied by family members who can help communicate with the medical team.

Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health, said the research findings have implications for health care reform in the United States.

“The body of studies suggest that if you insured much of the 37 million Americans without health insurance, lives would be saved and a great deal of suffering would be avoided because people would receive a quality of care that is difficult to get in the medical community now,” Blendon said.

“This study adds to a broader picture of the differences in what happens to the uninsured.”