nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Saturday, October 16, 2010

How Many Lives Are Saved When The Uninsured Are Covered?

There are several studies on this issue.  The Institute of Medicine estimated it at 18,000 per year.  But, no study (so far) accounts for all the factors involved.

A few days ago I was reading a transcript of the election debate between Senator Barbara Boxer of California and her challenger.  She was touting the potential of health care reform, and blithely said, "No longer will thousands of people die every day for lack of insurance coverage."

I was stunned at the exaggeration, and doubly so because nobody followed up to challenge it.  If you do the math, she's claiming about a million people a year die because they have no health insurance.  (Say, 2,000 x 365 days).

The highest estimate from the few available studies is 40K, and the lowest is zero.  The question gets complex because it's hard to estimate the impact of a subjective decision that may be in someone's mind ("should I go to the doctor?") and the data on mortality.  Note:  We're not talking about the health or well-being of the uninsured, only those who die.

This year's winner of  the John M. Eisenberg Article-of-the-Year Award, was published last year in the journal Health Services Research (21 Apr 2009).  The study did a fairly decent job of controlling for external variables and found the risk of dying due to lack of insurance coverage was no different than that for those who have coverage.

For Onion Peelers (the description is so well written, I'm just going to quote the results):
"National Health Interview Survey from 1986 to 2000 were followed prospectively for mortality from initial interview through 2002. Baseline information was obtained on 672,526 respondents, age 18–64 at the time of the interview. Follow-up information on vital status was obtained for 643,001 (96 percent) of these respondents, with approximately 5.4 million person-years of follow-up... Adjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline (hazard ratio 1.03, 95 percent confidence interval [CI], 0.95–1.12

Note that if you don't correct for obesity, smoking and health status there is a slighly increased hazard ratio (1.1 to 1.2).  They wanted to stick to an apples-to-apples comparison group.

US hospitals are required by law to not turn away patients who present for care, whether they have insurance or not.  So all who have an urgent need for medical care can get it.

This study challenges our assumptions.  We need more work in this area to understand the impact of health care availability.

In my clinical experience denial of symptoms is a bigger killer than lack of insurance.
Doc D

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