Enrollment barriers are part of the problem, explained Lesley, whose organization endorses legislative proposals to move toward a "default enrollment" system. "The presumption should be the kid's enrolled, and let's figure out what program they're in," he said.
The Johns Hopkins team looked at the relationship between insurance status and kids' mortality to better inform the CHIP debate.
Using records from two large databases, lead author Dr. Fizan Abdullah, Chang and colleagues examined more than 23 million hospitalizations of people younger than 18.
Over an 18-year period though 2005, 117 million children were hospitalized. Nearly 6 million kids were uninsured at the time of admission. In all, 38,649 children died while hospitalized.
Uninsured kids were 1.6 times more likely to die than children who had insurance.
Assuming that the insured and uninsured populations are identical, the difference in risk of mortality was 60 percent. The authors' actual predicted mortality is lower, however, because factors such as age, race and gender are associated with risks that affect outcomes, Chang explained.
"The 60 percent is the theoretical difference, and the 37 percent is the actual difference that you see in real life," he said. "Our extrapolation is based on that more conservative number."
The study includes some data from the period before CHIP was enacted in 1997. Though fewer kids are uninsured today than two decades ago, Chang said, that would not skew the risk of death from lack of insurance.
And though the study does not prove that being uninsured boosts a child's mortality risk, it does suggest a strong association between insurance status and odds of dying.
"I think the message is insurance i
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