United States: Lack of health coverage kills 45,000 each year

Issue 

The article below is by Physicians for a National Health Program, a research and educational organisation of 17,000 doctors who support single-payer national health insurance in the United States. The study referred to can be found at MRZine.

A new study estimated that nearly 45,000 annual deaths in the United States are associated with lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The study, Health Insurance and Mortality in US Adults was published in the American Journal of Public Health.

The Harvard-based researchers found that uninsured, working-age US people have a 40% higher risk of death than their privately insured counterparts. This is up from a 25% excess death rate found in 1993.

Lead author Dr Andrew Wilper, who worked at Harvard Medical School when the study was done and now teaches at the University of Washington Medical School, said: "The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health.

"We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications."

The study, which analysed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors —including smoking, drinking, and obesity — into account.

It estimated that lack of health insurance caused 44,789 excess deaths annually.

Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease.

An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths associated with lack of insurance. The uninsured are more likely to go without needed care.

Another factor contributing to the widening gap in the risk of death between those who have insurance and those who don't is the improved quality of care for those who can get it.

The research, carried out at the Cambridge Health Alliance and Harvard Medical School, analysed US adults under 65 who participated in the annual National Health and Nutrition Examination Surveys (NHANES) between 1986 and 1994.

Respondents first answered detailed questions about their socioeconomic status and health, and were then examined by physicians. The CDC tracked study participants to see who died by 2000.

The study found a 40% increased risk of death among the uninsured.

As expected, death rates were also higher for males (37% increase), current or former smokers (102% and 42% increases), people who said that their health was fair or poor (126% increase), and those that examining physicians said were in fair or poor health (222% increase).

Dr Steffie Woolhandler, study co-author, professor of medicine at Harvard and a primary care physician, noted: "Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance.

"Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.

"Even the most liberal version of the House bill would have left 17 million uninsured, according to the Congressional Budget Office. The whittled down Senate bill will be worse — leaving tens of millions uninsured, and tens of thousands dying because of lack of care.

"Without the administrative savings only attainable through a Medicare-for-all, single-payer reform — real universal coverage will remain unaffordable. Politicians are protecting insurance industry profits by sacrificing American lives."

Dr David Himmelstein, study co-author and an associate professor of medicine at Harvard, said: "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance.

"Even this grim figure is an underestimate — now one dies every 12 minutes."