SUNNYBROOK HEALTH SCIENCES CENTRE

SUNNYBROOK HEALTH SCIENCES CENTRE

April 30, 2010 08:31 ET

CRITICAL CARE OUTCOMES IN U.S. TIED TO INSURANCE STATUS

Attention: Assignment Editor, Health/Medical Editor, Media Editor, News Editor, World News Editor TORONTO, ONTARIO, MEDIA ADVISORY--(Marketwire - April 30, 2010) - Among the general U.S. population, people who are uninsured are about half as likely to receive critical care services as those with insurance, according to a study by the American Thoracic Society's Health Disparities Group. They also found that once admitted to the hospital intensive care unit, uninsured patients are less likely to have invasive procedures or pulmonary artery catheterizations and more likely to experience delay in discharge, and have life support withdrawn.

"Patients who do not have health insurance and become critically ill receive fewer critical care services and may experience worse clinical outcomes," said Dr. Robert Fowler, lead author of the review and Critical Care physician at Sunnybrook Health Sciences Centre in Toronto. "Improving preexisting health care coverage may be one mechanism to reduce such disparities."

The researchers reviewed more than 5,500 citations on critical care and insurance status, ultimately identifying 29 observational studies that described the admissions and outcomes for critically ill patients with and without insurance.

The results were published as an official systematic review in the May 1 issue of the American Journal of Respiratory and Critical Care Medicine.

Currently, one-third of the population under the age of 65 is uninsured for a portion of any given year, and the costs of critical care are approaching one percent of the U.S. gross domestic product.

"We found that although uninsured patients were less likely to receive critical care services overall, uninsured patients in emergency rooms were more likely to require admission to the intensive care unit. This might occur if the uninsured delayed going to a hospital until experiencing a more advanced stage of illness," wrote Dr. Fowler, associate professor of medicine at the University of Toronto. "That the uninsured were perhaps less likely to use an ambulance to get to the hospital provides some support for this concept."

"Although U.S. hospitals are legally obligated to care for patients who are emergently ill, they are not obligated to be the continuing provider for medically stabilized uninsured patients," Dr. Fowler noted. "The increase in discharge delay may be due to the "difficulty in finding healthcare providers or facilities to accept these patients."

Overall, lack of insurance is independently associated with reduced access to care and poorer outcomes. "Developing more comprehensive programs and legislation to improve health coverage for patients who are acutely ill would therefore seem a logical avenue for investigation," the authors conclude.

The authors also comment that while increasing access to insurance inevitably raises concerns about costs, the costs of underinsurance are already borne by society at large, as uninsured patients rely more heavily on emergent care, and the responsibility for unpaid bills falls to the states and ultimately the tax payers. Furthermore, concerns about possible over-usage are not substantiated by research. Recent evidence shows that individuals who move from no insurance to more comprehensive coverage do not use more resources than the consistently and long-term insured.

"[O]ur review indicates that there may be inequalities in the provision of care to a vulnerable segment, that is, those who are very sick and in need of care but who cannot afford care," concluded the authors. "Even with increased access to health insurance, other factors such as poverty, limited health literacy, limited social support, and homelessness will continue to conspire against equitable care. As a society, we should urgently explore options to reduce such disparities across the population and particularly for those most vulnerable and those most in need."

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Media Contact:
Laura Bristow, Communications Advisor, Sunnybrook Health Sciences Centre
416-480-4040
IN: ECONOMY, HEALTH, INTERNATIONAL, LABOUR

Contact Information

  • Laura Bristow, Communications Advisor, Communications & Stakeholder Relations
    Primary Phone: 416-480-4040