Uninsured Patients Fare Worse, and No One Knows Why

When someone is wheeled into an emergency room, bleeding or writhing in pain, it's illegal for doctors or hospital administrators to try to ascertain whether the patient has insurance before administering treatment. So it's really, really confusing to find out that uninsured patients are more likely to die in hospitals after car accidents and gunshot wounds than their peers who have health insurance.

This isn't one study's conclusion. It's study after study after study. The latest, from the University of Buffalo, looked at close to 192,000 patients who visited 649 trauma centers from 2001 to 2005. Controlling for age, sex, race and everything else you can think of, researchers found that people without insurance were 1.8 times more likely to die from blunt trauma injuries like car crashes, falls and fights, and 2.6 times more likely to die from penetrating trauma, like shootings and stabbings.

Usually after a study tells you what, it will also attempt to tell you why. But in this case, nobody can figure it out. Since doctors may not even know the insurance status of their patients, it's hard to charge them with classism or racism or discrimination. Could the problems lie with the patients themselves?

"If you have been shot by a gun and don't have insurance, it's very possible that you may delay seeking care. If you are uninsured, you are likely to drive an older, less safe vehicle," said the lead author of the study, trying to put the findings in context.

Social determinants of health, from lead paint in low-income housing to the prevalence of HIV in poor communities, aren't news to poverty advocates. But I'm still having a hard time figuring out how they translate to worse treatment within the walls of a hospital. Besides the fact that not all hospitals are created equal, the argument that makes the most sense to me is the generally worse well-being of the uninsured. In addition to the lack of access to pre or post-trauma check-ups, obesity, diabetes and a host of other poverty-targeting diseases make new conditions even harder to treat. Knowing that, allowing food stamps to be used at farmers' markets — and a hundred similar measures — could be called preventive medicine.

Photo credit: markhillary