No Health Insurance? Mortality Rates are Higher


If you do not have health insurance, your chances of dying if hospitalized for acute myocardial infarction (AMI), stroke, or pneumonia are significantly higher than if you are privately insured. An evaluation of more than 150,000 hospital discharges shows higher mortality rates related to these three leading causes of non-cancer, inpatient deaths.

Having no health insurance and dying because of it has been a growing concern. In 2002, the Institute of Medicine (IOM) estimated that 18,000 American had died in 2000 because they lacked health insurance. In subsequent studies, based on the IOM’s methodology and Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they did not have insurance, including 22,000 people in 2006.

In this new analysis, which was published in the Journal of Hospital Medicine, researchers analyzed 154,381 hospital discharge records for people ages 18 to 64 who were admitted for AMI, stroke, or pneumonia. Compared with individuals who have private health insurance, hospitalized patients without health insurance fared worse: hospital mortality among those with AMI was 52 percent higher and for those with stroke, 49 percent higher. Among Medicaid recipients with pneumonia, the mortality rate was 21 percent higher.


Some uninsured patients also had longer hospital stays, including Medicaid recipients who were hospitalized for any of the three conditions studied. Hospital costs were also higher for patients without health insurance who were also Medicaid recipients treated for stroke or pneumonia, but not AMI.

Lead author Dr. Omar Hasan, of Harvard Medical School and Brigham and Women’s Hospital in Boston, stated that he hoped results of the current study “will provoke policymakers, healthcare administrators, and practicing physicians to consider devising policies to address potential insurance related gaps in the quality of inpatient care.”

Compared with people who have private insurance, those without health insurance or who are Medicaid recipients were generally younger, less likely to be white, more likely to have a lower income, and more likely to be admitted to the hospital through the emergency department (ED). The higher mortality rate could be related to being admitted through the ED, which could indicate more serious illness at the time of admission, which in turn could be due to uninsured people delaying treatment.

Dorn S. Uninsured and dying because of it. Institute of Medicine analysis on the impact of uninsurance on mortality. 2008.
Hasan O et al. Journal of Hospital Medicine 2010; DOI: 10.1002/jhm.687