Studies reveal fallout of no medical insurance

Many points are hotly disputed during the current debate over health reform. But not this one: Going without health insurance is harmful to people's health.

It's notable that reform critics don't seriously challenge the conclusion. But it's not surprising, because numerous studies show that people who are uninsured put off preventive care, become sicker and are more likely to die.

The Institute of Medicine estimates that about 18,000 people perish each year because they don't have health insurance.

Now, two new studies add to our understanding of the consequences of being uninsured.

The first, published Oct. 30 in the Journal of Public Health, reports that uninsured children who are hospitalized are almost 60 percent more likely to die than those with insurance.

That may be because their families can't afford ongoing medical care and children are sicker when they come to the hospital, speculated Dr. Fizan Abdullah, lead author and an assistant professor at the Johns Hopkins School of Medicine. Or it may be that families are disadvantaged in other ways that affect their health.

Based on an analysis of 23 million hospital records, Abdullah and co-authors say that 16,787 children died in hospitals between 1988 and 2005 because they lacked medical coverage. Because uninsured children who lose their lives outside hospitals aren't included, the number of deaths is probably much higher, Abdullah noted.

"Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," said co-author David Chang, also of Johns Hopkins. "The point here is that a substantial number of children may be saved by health coverage."

The second study, published online by Health Affairs on Oct. 20, reports that large numbers of uninsured adults have chronic illnesses that are undiagnosed and undertreated. Its Harvard University authors, Dr. Steffie Woolhandler and Dr. David Himmelstein, are well known advocates for universal health insurance.

According to their analysis of nearly 16,000 individuals, 46 percent of uninsured adults with diabetes were unaware they had the condition, while 52 percent of uninsured adults with high cholesterol didn't know their status, the researchers discovered. The conclusion comes from comparing answers on government surveys with results from medical exams and tests.

Meanwhile, more than 77 percent of uninsured adults had poorly controlled cholesterol, while 58.3 percent had poorly controlled blood pressure, researchers found.

The study suggests that millions of uninsured adults aren't getting "care that would prevent strokes, heart attacks, amputations and kidney failure," said lead author Dr. Andrew Wilper of the University of Washington Medical School.

For consumers, the message is clear. If you lose medical coverage and start skimping on care, you and your family might suffer preventable medical setbacks.