New Study shows Uninsured Trauma Patients 80% More Likely to Die than Insured

Hi there everyone -

As I walked into work the other day, I was surprised to find an article posted on the board with the above headline. Wow - Uninsured Trauma Patients 80% more likely to die than the Insured.

The study was conducted by Harvard University and Brigham and Women's Hospital in Boston and the information was extrapolated from the National Trauma Data Bank. They looked at 2.7 million patients from 900 different trauma centers across the US.

This surprised many trauma hospitals, physicians and staff because of the EMTALA laws. These laws are supposed to protect patients without insurance. Anyone presenting to an emergency room is supposed to be treated equally without regard to insurance coverage.

The study seems to conclude otherwise. Patients with private insurance, HMOs and Medicaid all seems to fair equally. Medicare patients died 56% more often and the Uninsured patients died 80% more often.

The researchers thought that the Medicare population was adversely affected by their chronic medical conditions and age. So, they next decided to remove the age and chronic condition criteria - they concentrated on 200,000 + patients from 18 - 30 years of age. Surprisingly the numbers got worse, those uninsured individuals died 89% more often than their insured counterparts.

So why is this happening???? I work in an ER and I still think that we treat anyone that walks through our doors - I don't believe that we withhold care from the uninsured. Anyone else experiencing anything different?

Some studies do show that the uninsured do wait longer to go to the hospital for treatment, maybe too late. Others don't seek care for their chronic conditions so this could make recovery from a trauma more complicated. Studies do show that uninsured individuals do get less testing done and are transferred to rehab. facilities less frequently.

I believe it could also have to do with the type of traumatic injuries these patients are suffering. The age range seems to indicate that maybe the high risk behaviors they participate in and the injuries they suffer from them attribute to these numbers. But then again, why are the insured in this age group surviving more?

I also believe it may have something to do with the course of the treatment of the uninsured. I believe that the uninsured do get the same treatment in the ER or trauma center- but I do believe at some point after stabilization, these patients may get transferred to some other hospital or rehab centers. Post -stabilization care, treatments, tests and maybe even staffing or after discharge followup and compliance may also be hidden factors in these outcomes.

So I hate to sound like a broken record - but how much money do we sink into these bad outcomes? Would it change if we insured everyone? Would it cost less to save them? Maybe they would get out of the hospital sooner if we were already treating their chronic conditions.
Are we proving that we give sub maximal care to the uninsured?

What do you think?