Study: Uninsured Don't Get Needed Health Care Delayed Diagnoses, Premature Deaths Result By Ceci Connolly Washington Post Staff Writer Wednesday, May 22, 2002; Page A03 The lack of health insurance in America leads to delayed diagnoses, life-threatening complications and, ultimately, 18,000 premature deaths each year, according to a report released yesterday by the Institute of Medicine. In the first comprehensive study of the medical consequences of going without insurance, researchers commissioned by the National Academy of Sciences found that "being uninsured for even a year appears to diminish a person's general health." Despite the popular belief that uninsured Americans simply walk into the hospital for medical services, the vast majority go without health care until an illness becomes too serious to ignore. "Because we don't see many people dying in the streets in this country, we assume that the uninsured manage to get the care they need, but the evidence refutes that assumption," said Mary Sue Coleman, president of the Iowa Health System and co-chair of the committee that wrote the report. "The fact is that the quality and length of life are distinctly different for insured and uninsured populations." Many of the 30 million working Americans without insurance belatedly discover serious illnesses such as cancer, diabetes, hypertension and HIV. Others may go their entire lives without receiving treatment for a mental illness, high cholesterol, arthritis or asthma, the authors found. "It is very important folk have access to health care early before they are ill and that they have access to a full range of basic services," said committee member Reed Tuckson, a senior vice president at United Health Group. After a detailed analysis of 130 studies on the uninsured, the group estimated that a lack of insurance translates annually into 360 to 600 premature breast cancer deaths, 1,200 to 1,400 deaths among HIV-infected adults and 1,400 premature deaths due to undertreated hypertension. "This is a major American problem," said Tuckson, who specializes in consumer health. "It is a tragedy of numbers." The central message of the report and its authors is that prevention and early diagnosis have an enormous impact on mortality, quality of life and even costs. In the case of diabetes, early detection enables patients to monitor blood-sugar levels and get regular foot and eye exams. The report found that 25 percent of uninsured diabetics went without a checkup for two years, compared with 5 percent for those with insurance. Hypertension and high cholesterol often can be controlled with medication and diet. But lacking insurance, those patients "have diminished access to care, are less likely to be screened, are less likely to take prescription medication if diagnosed, and experience worse health," the report said. Because the uninsured are less likely to receive common cancer screening tests such as mammograms, Pap smears and colon exams, they die sooner than people with insurance. "The problem of later diagnosis and higher mortality among uninsured women with breast cancer, for example, cannot be solved by insuring women once the disease is diagnosed," the authors note. Even when a person without insurance gets to a hospital, that patient is less likely to be admitted and more likely to receive fewer services. "Often one of the first pieces of information obtained" in the emergency room is insurance status, said committee member John Ayanian, a health policy expert at Harvard Medical School. One study found that uninsured patients with cardiovascular trouble are less likely to be admitted to a hospital that performs angiography; another found that the risk of death after arriving at the hospital was 37 percent higher among the uninsured. More significantly, Ayanian said: "Emergency rooms are not equipped to diagnose people early or treat chronic illness." Conversely, a person with health coverage is more likely to develop a relationship with a physician, undergo periodic screening and be better educated about healthy lifestyles. People with insurance are also more inclined to seek services that are not covered. Of the 40 million Americans without insurance, about 30 million are adults ages 18 to 65. Nearly 85 percent of uninsured adults work or live in families in which someone works. Forgoing health insurance "is not a cavalier decision," Coleman said. "Most people don't have the resources" to pay premiums and copayments -- if an employer offers some type of coverage. Although the report focused on medical outcomes, the committee suggested other, less tangible benefits come with health insurance. "Financial security and stability, peace of mind, alleviation of pain and suffering, improved physical function, disabilities avoided or delayed, and gains in life expectancy" are among the advantages, they concluded. "For many of the 40 million uninsured Americans, these benefits remain out of reach." � 2002 The Washington Post Company http://www.washingtonpost.com/wp-dyn/articles/A52828-2002May21.html __________________________________________________ Do You Yahoo!? LAUNCH - Your Yahoo! Music Experience http://launch.yahoo.com
