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ATS systematic review: Critical care outcomes tied to insurance status
Date:4/28/2010

anced 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 t
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Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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