Navigation Links
ATS systematic review: Critical care outcomes tied to insurance status

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 systematic review of the literature 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are less likely to have invasive procedures or pulmonary artery catheterizations and more likely to have life support withdrawn.

"Patients in the United States who do not have health insurance and become critically ill receive fewer critical care services and may experience worse clinical outcomes," said J. Randall Curtis, M.D., M.P.H., president of the ATS, and an investigator for the review. "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 is approaching one percent of the U.S. gross domestic product.

In addition to reduced services and greater discharge delays among uninsured, the review found that while uninsured patients were slightly more likely to be admitted overall, the difference was not statistically significant, those with traumatic injuries were 63 percent as likely to be admitted as those with insurance.

"The finding that the uninsured were more likely to be admitted to the ICU after arriving at the hospital could occur if the uninsured delayed going to a hospital until experiencing a more advanced stage of illness," wrote Robert Fowler, M.D., associate professor of medicine at Sunnybrook Hospital, the University of Toronto, and lead author of the systematic review. "That the uninsured were perhaps less likely to use an ambulance to get to the hospital provides some support for this concept."

Finally, uninsured patients were more likely to face discharge delays.

"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. "We found evidence that patients who are critically ill with lesser degrees of insurance coverage receive fewer critical care services compared with those who have more insurance. 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.

While increasing access to insurance inevitable 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 ultimate 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."


Contact: Keely Savoie
American Thoracic Society

Related medicine news :

1. Biomedical Industry Jobs Critical to California's Economic Recovery, Finds California Healthcare Institute and PricewaterhouseCoopers
2. Caregivers of ICU patients are collateral damage of critical illness, say Pitt researchers
3. Congress Urged to Take Immediate Action to Ensure Frail Patients Continue to Receive Critical Therapy Services
4. In Earthquake Aftermath, Response Time is Critical: How MEDEX Global Solutions Protected Clients and Travelers
5. Scientists discover cells critical to childhood leukemia
6. Disclosing sexual abuse is critical
7. Huntington Hospital Uses New Technology to Assist Nurses; Voalte iPhone Application Improves Critical Communication at Point-of-Care
8. Studies Show Doctors Rapidly Forget Critical, Life-Saving Skills such as CPR and Life Support
9. Patient Advocates Cite Insurance Caps as Critical Difference in Senate and House Health Care Reform
10. Optimizing Corporate Culture is Critical to the Success of Wellness Programs
11. Coalition for Patients' Rights: Access to Broad Range of Health Care Providers Critical to Lowering Costs
Post Your Comments:
(Date:6/25/2016)... (PRWEB) , ... June 25, 2016 , ... The temporary closing of Bruton Memorial Library ... City Observer , brings up a new, often overlooked aspect of head lice: the parasite’s ... for fumigation is not a common occurrence, but a necessary one in the event that ...
(Date:6/25/2016)... TX (PRWEB) , ... June 25, 2016 , ... ... the United States, named Dr. Sesan Ogunleye, as the Medical Director of its new ... the facility Medical Director of our new Mesquite location,” said Dr. James M. Muzzarelli, ...
(Date:6/25/2016)... ... June 25, 2016 , ... Dr. Calvin Johnson has ... he has implemented orthobiologic procedures as a method for treating his patients. The ... first doctors to perform the treatment. Orthobiologics are substances that orthopaedic surgeons use ...
(Date:6/25/2016)... Canada (PRWEB) , ... June 25, 2016 , ... Conventional ... pursuit of success. In terms of the latter, setting the bar too high can ... risk more than just slow progress toward their goal. , Research from ...
(Date:6/24/2016)... Michigan (PRWEB) , ... June 24, 2016 , ... Those ... deal with these feelings, many turn to unhealthy avenues, such as drug or alcohol ... of Marne, Michigan, has released tools for healthy coping following a traumatic event. , ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... June 23, 2016 Research and Markets ... Market - Forecast to 2022" report to their offering. ... method for the patients with kidney failure, it replaces the ... from the patient,s blood and thus the treatment helps to ... chloride in balance. Increasing number of ESRD ...
(Date:6/23/2016)... , June 23, 2016 Research and ... Devices Medical Market Analysis 2016 - Forecast to 2022" ... The report contains up to date financial data derived ... Assessment of major trends with potential impact on the market ... of market segmentation which comprises of sub markets, regional and ...
(Date:6/23/2016)... INDIANAPOLIS , June 23, 2016 ... Tomorrow,s Leaders Scholarship is any indication, the future is ... online at by the Diabetes Scholars ... in the way of academic and community service excellence. ... program since 2012, and continues to advocate for people ...
Breaking Medicine Technology: