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Uninsured Face Worse Outcomes After Diverticulitis
Date:12/15/2008

reatment provided," they wrote. "Uninsured and underinsured patients were more likely to receive a colostomy -- even after adjusting for a higher rate of complicated diverticulitis [seen] in those patients than their insured counterparts."

Colostomy is the creation of a surgical opening through the abdominal wall to allow for waste removal.

The study results have wide implications for health policy, Chang said.

"A racial disparity in diverticulitis outcomes has been described for decades," he said. "But African-American patients are less likely to be insured. What this is showing is that insurance is a contributor to the disparity in racial outcomes."

The Hopkins group has done a similar study of trauma patients -- it found the same effect of health insurance status on patient outcomes, Chang noted. These studies should be considered when national health plans are being drawn up, he said, since it now appears that "[having] insurance can ameliorate the effect of race."

"The policy implication is that when you don't see equal care, we should focus on designing interventions to get equal care," added Dr. Selwyn O. Rogers Jr., an associate professor of surgery at Harvard Medical School and Brigham and Women's Hospital, who wrote an accompanying commentary on the study.

Someone who has a single episode of diverticulitis is likely to have recurrences, Rogers noted.

"If you have an excellent health insurance plan, you get referred to helpful surgeons and high-quality hospitals," he said. "Hopefully, you don't present with the kind of complications that might require colostomy."

About one in five Americans in a 2007 survey reported either delaying needed medical treatment or foregoing it altogether, Rogers noted in his commentary. "This dramatic decline in access to both medical and surgical care is alarming," he wrote.

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