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Insurance Status and Trauma Care in Massachusetts as Studied in 1994: Have There Been Changes?
The following paper is a study from 1994. It concludes essentially that uninsured trauma patients obtained less care and died with a greater frequency than those trauma patients who had insurance.
What follows is an excerpt from the paper, the paper's PubMed entry and the links to two criticisms with their respective responses as published in the AJPH Letters to the Editor section:
Acutely Injured Patients with Trauma in Massachusetts: Differences in Care and Mortality, by Insurance Status
Jennifer S. Haas, MD, MSPH, and Lee Goldman, MD, MPH
Introduction
Trauma is the fourth leading cause of death in the United States(1), and it results in substantial morbidity. The annual cost of traumatic injuries is estimated to be more than $100 billion(2). Some data suggest that 30% of trauma-related deaths may be prevented by appropriate prehospital and in-hospital care(3,4).
Although previous work has demonstrated that the uninsured (5-8) are less likely to receive certain health care services, these studies have usually examined elective procedures or ambulatory services for which differences in rates of use may reflect patients' preferences. In addition, it has been difficult to control for differences in disease severity for chronic medical problems(9). Finally, differences in procedure rates may not be associated with differences in health outcomes. Because of these limitations, no conclusions can be drawn as to the appropriateness of the observed variation.
To address whether lower rates of resource use by uninsured patients are associated with worse health outcomes, we studied patients with acute trauma. Since these patients are acutely injured, the relationship between in-hospital care and mortality may be more direct than for chronic health problems. Also, patients' preferences are less likely to explain differences in the use of procedures. Furthermore, the severity of injury can be measured reliably for patients with traumatic injuries in administrative data sets. The goal of this study was to examine whether resource use and mortality differed by insurance status for patients hospitalized with acute trauma.
...
AJPH Paper: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.10.1605
Jennifer S. Haas, MD, MSPH, and Lee Goldman, MD, MPH
Introduction
Trauma is the fourth leading cause of death in the United States(1), and it results in substantial morbidity. The annual cost of traumatic injuries is estimated to be more than $100 billion(2). Some data suggest that 30% of trauma-related deaths may be prevented by appropriate prehospital and in-hospital care(3,4).
Although previous work has demonstrated that the uninsured (5-8) are less likely to receive certain health care services, these studies have usually examined elective procedures or ambulatory services for which differences in rates of use may reflect patients' preferences. In addition, it has been difficult to control for differences in disease severity for chronic medical problems(9). Finally, differences in procedure rates may not be associated with differences in health outcomes. Because of these limitations, no conclusions can be drawn as to the appropriateness of the observed variation.
To address whether lower rates of resource use by uninsured patients are associated with worse health outcomes, we studied patients with acute trauma. Since these patients are acutely injured, the relationship between in-hospital care and mortality may be more direct than for chronic health problems. Also, patients' preferences are less likely to explain differences in the use of procedures. Furthermore, the severity of injury can be measured reliably for patients with traumatic injuries in administrative data sets. The goal of this study was to examine whether resource use and mortality differed by insurance status for patients hospitalized with acute trauma.
...
AJPH Paper: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.10.1605
Am J Public Health. 1994 Oct;84(10):1605-8.
Acutely injured patients with trauma in Massachusetts: differences in care and mortality, by insurance status.
Haas JS, Goldman L.
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
Abstract
OBJECTIVES: This study was designed to determine whether resource use and mortality differed by insurance status for patients with acute trauma.
METHODS: All adults emergently hospitalized in Massachusetts during 1990 with acute trauma (n = 15,008) were examined.
RESULTS: After adjustment for confounders, uninsured patients were as likely to receive care in an intensive care unit as were patients with private insurance (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.85, 1.11) but were less likely to undergo an operative procedure (OR = 0.68, 95% CI = 0.63, 0.74) or physical therapy (OR = 0.61, 95% CI = 0.57,0.67) and were more likely to die in a hospital (OR = 2.15, 95% CI = 1.44, 3.19). Compared with patients with private insurance, those with Medicaid were less likely to receive an operative procedure (0.85, 0.75-0.97), were equally likely to receive care in an intensive care unit (OR = 1.05, 95% CI = 0.86, 1.30) or physical therapy (OR = 0.90, 95% CI = 0.79, 1.02), and were no more likely to die (OR = 1.28, 95% CI = 0.69,2.39).
CONCLUSIONS: These results suggest that the uninsured receive less trauma-related care and have a higher mortality rate. The excess mortality in uninsured patients may be avoided if their resource use is increased to that of insured patients.
PubMed Entry: http://www.ncbi.nlm.nih.gov/pubmed/7943478
Acutely injured patients with trauma in Massachusetts: differences in care and mortality, by insurance status.
Haas JS, Goldman L.
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
Abstract
OBJECTIVES: This study was designed to determine whether resource use and mortality differed by insurance status for patients with acute trauma.
METHODS: All adults emergently hospitalized in Massachusetts during 1990 with acute trauma (n = 15,008) were examined.
RESULTS: After adjustment for confounders, uninsured patients were as likely to receive care in an intensive care unit as were patients with private insurance (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.85, 1.11) but were less likely to undergo an operative procedure (OR = 0.68, 95% CI = 0.63, 0.74) or physical therapy (OR = 0.61, 95% CI = 0.57,0.67) and were more likely to die in a hospital (OR = 2.15, 95% CI = 1.44, 3.19). Compared with patients with private insurance, those with Medicaid were less likely to receive an operative procedure (0.85, 0.75-0.97), were equally likely to receive care in an intensive care unit (OR = 1.05, 95% CI = 0.86, 1.30) or physical therapy (OR = 0.90, 95% CI = 0.79, 1.02), and were no more likely to die (OR = 1.28, 95% CI = 0.69,2.39).
CONCLUSIONS: These results suggest that the uninsured receive less trauma-related care and have a higher mortality rate. The excess mortality in uninsured patients may be avoided if their resource use is increased to that of insured patients.
PubMed Entry: http://www.ncbi.nlm.nih.gov/pubmed/7943478
AJPH Criticism and Response I: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.85.8_Pt_1.1164
AJPH Criticism and Response II: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.86.3.407-a
