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‘The accidental cost of being uninsured’

trauma graph.bmpHere’s some more fuel for the fiery healthcare debate in the United States: if you don’t have health insurance you’re more likely to die after traumatic injury.

Heather Rosen, of Harvard Medical School, and her colleagues analysed the data in the US National Trauma Data Bank from 2002 to 2006. A crude analysis found the uninsured had a 39% higher risk of dying in hospital following traumatic injury, such as a car accident, versus the insured.

When corrected for sex, race, age, injury severity and injury mechanism the uninsured had an 80% higher chance of dying. Looking just at young patients, who would likely have fewer other health issues, found the uninsured were at 89% increased risk, they write in Downwardly Mobile – the accidental cost of being uninsured, a paper in Archives of Surgery.

“This concerning finding warrants more rigorous investigation to determine why such variation in mortality would exist in a system where equivalent care is not only expected but mandated by law,” write the authors. “Although the lack of insurance may not be the only explanation for the disparity in trauma mortality, the accidental costs of being uninsured in the United States today may be too high to continue to overlook.”

It’s not entirely clear why the uninsured should be so disadvantaged. It may be they experience delays in treatment, they may receive different treatment, or they may be less able to communicate with doctors due to poor ‘health literacy’, say Rosen et al.

The authors also note that the database they use may not be representative of the US as a whole.

Despite these problems, in an invited critique of the article, Brent Eastman, of Scripps Memorial Hospital La Jolla in San Diego, says it is “disturbing to see from this study that, even with guaranteed access, the uninsured have a higher adjusted mortality rate after trauma”.

He adds, “Inclusive trauma systems in the United States are designed to ensure that all trauma patients have expeditious transfer to the level of care commensurate with their injuries regardless of insurance status. Such systems should also guarantee the same level and quality of care to all patients.”

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    boat fenders said:

    All the Statistics given in the article are really shocking. I think that Taking Insurance is a better option than taking the risk of being pay the accidental cost of being uninsured.

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