Thursday, December 20, 2007

The Cost Of Not Having Health Insurance

A new study tells us something that is not unexpected: You are more likely to die when you don't have health insurance:

Ward and colleagues looked at data from 598,635 cases in the National Cancer Data Base (NCDB). The NCDB is held by the ACS and collects data from 1,500 hospital registers. It tracks about 70 per cent of the cancer cases in the US.

They also included information from the 2005 and 2006 National Health Interview Survey (NHIS), which covers about 40,000 American households and is carried out by the National Center for Health Statistics (NCHS) of the US Centers for Disease Control and Prevention (CDC).

The patients in the sample were either privately insured, covered by Medicaid (the government scheme for individuals and families on low incomes), or not insured at all.

The results showed that:

* Patients on lower incomes were less likely to have insurance.

* Patients without insurance were less likely to use certain health services.

* For all cancers, uninsured patients were 1.6 times more likely to die within 5 years than individuals with private insurance.

* About 54 per cent of patients aged 18 to 64 without insurance did not have a usual source of health care.

* Nearly 23 per cent of patients without insurance did not get care because of the cost.

* About 26 per cent of patients without insurance delayed care because of the cost.

* About 23 per cent did not get prescription drugs because of the cost.

* Patients with health insurance were twice as likely to have had a recent mammogram or screening for colorectal cancer, compared to the uninsured.

* Regardless of race or ethnicity, women without health insurance were half as likely to have had a mammogram in the last two years compared with women who were insured.

* About 48 per cent of insured adults aged 50 to 64 underwent colorectal cancer screening compared with 19 per cent uninsured.

* Insured patients were more likely to have been diagnosed early and less likely to have an advanced cancer diagnosis compared with uninsured patients.

* About 89 per cent of insured white women with breast cancer survived at least 5 years.

* This compared with 76 per cent of white women on Medicaid or no insurance.

* About 81 per cent of African-American women with breast cancer survived at least 5 years.

* This compared with 65 per cent of African-American women on Medicaid and 63 per cent of those with no insurance.

* There was a similar pattern for colorectal cancer.

Not having insurance can kill you.

That women on Medicaid, the government health insurance system for some selected groups of the poor, also had higher death rates than those with other types of insurance suggests to me either that Medicaid is a little bit like not having insurance, what with the large number of doctors who don't accept it because of its low reimbursement rates, or that the study still failed to control for something else associated with poverty, something which affects mortality rates.

The study author also pointed out that the lack of insurance doesn't explain all the mortality differences by race or ethnic group. I wonder if controlling for income and education at the same time would do that? Or if environmental factors from, say, living in polluted and dangerous areas would still exert an independent effect?