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Deaths of Hospitalized Children Linked to Lack of Insurance


In research published online in the October 30th Journal of Public Health, researcher Fizan Abdullah, MD, PhD, assistant professor of surgery at Johns Hopkins School of Medicine, found that children without insurance are 60% more likely to die from a serious illness than a sick child that does have insurance.

Abdullah and colleagues analyzed 23 million pediatric inpatient hospital records from 37 states covering the years 1988 to 2005, comparing the risk of death of children with insurance to those without it. 117 million children were hospitalized during this time with 6 million uninsured. 38,649 uninsured children died while hospitalized.

Even after taking into account factors such as age, race, gender, and hospital region, uninsured children were still 37.8% more likely to die. The most common reasons for children being hospitalized were complications from birth, pneumonia and asthma.

More uninsured children were seen in hospitals in the Northeast and Midwest than in the South and West. However, hospitals from the Northeast had lower mortality rates than hospitals from the South, Midwest and West.

The uninsured appeared to have an increased risk of dying regardless of their medical conditions. The findings do not count children who died without ever being hospitalized or after hospital discharge, which means the death rate of non-insured kids could have been higher.

Although the research was not set up to identify why the uninsured were more likely to die, one cause was identified – uninsured were more likely to gain access to care through the emergency room rather than primary care physicians which may suggest that the condition was more advanced by the time they were hospitalized.

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Dr. Abdullah dismissed the possibility that providers gave less care or denied procedures to the uninsured. “The children who were uninsured literally died before the hospital could provide them more care,” Dr. Abdullah said. Alison Buist, director of child health at the Children’s Defense Fund, said “If you wait until a child gets care at a hospital, you have missed an opportunity to get them the types of screening and preventive services that prevent them from getting to that level of severity to begin with.”

Earlier studies have found that uninsured children are more likely than insured children to have unmet medical needs, like untreated asthma or diabetes, and are more likely to go for two years without seeing a doctor.

The authors write that the findings are in line with that seen in adult patients. The US Institute of Medicine has reported data that adults who are uninsured have a higher mortality rate. A recent Harvard study found that about 45,000 Americans die each year due to lack of health insurance.

In a news release, David Chang, PhD, MPH, MBA, the study co-author, says he can’t be certain that the children who died might have lived, had they had health insurance, but the researchers assert that from a scientific perspective thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance.”

President Obama has authorized legislation for children’s healthcare. In January, he signed legislation reauthorizing the Children’s Health Insurance Program (CHIP) that provides funding for states through 2013. The program, which began in 1997, provides insurance for about 7 million children in the United States. The recent expansion should increase the number of children provided with insurance to about 14 million, according to estimates by the Congressional Budget Office.

It is estimated that about 7 million children in the United States remain uninsured as the nation struggles with health care reform. Many of those children qualify for programs such as Medicaid or CHIP, but enrollment barriers are cited as one of the problems for lack of insurance.

Sources Include: US News, Johns Hopkins Childrens Center, and the Centers for Medicaid and Medicare Services