News Roundup [abridged Versions Appear In The Paper Journal]

Uninsured Americans are more likely to die prematurely

BMJ 2002; 324 doi: (Published 01 June 2002) Cite this as: BMJ 2002;324:1296
  1. Charles Marwick
  1. Washington

    Lack of health insurance is a risk factor for poor health. Americans who lack such insurance are in poorer general health, receive inadequate care, and are more likely to die prematurely than people with insurance.

    This is the conclusion of a new report from the US Institute of Medicine. The report was prepared by the institute's committee on the consequences of uninsurance and is the second of six reports the committee is issuing. The first report appeared last October.

    The committee examined the consequences of being uninsured for adult patients with a number of specific conditions: cancer, diabetes, HIV infections and AIDS, heart and kidney disease, mental illness, and traumatic injuries. The report says that overall “uninsured patients have consistently worse clinical outcomes than insured patients.”

    In patients with cancer, for example, the uninsured have a 50% greater chance of dying and die sooner than patients who have insurance—largely owing to delayed diagnosis. Even patients who experience traumatic injury are less likely to survive if they lack insurance.

    Diabetic people without health insurance are more likely to have uncontrolled blood sugar concentrations and to fail to receive regular foot and eye examinations to detect the circulatory problems that can result in amputation or blindness. The report cited studies showing that 25% of diabetic adults without insurance failed to receive such examinations over a two year period, compared with 5% of diabetic adults who had insurance.

    Much the same picture emerges from the committee's review of the other conditions. Uninsured AIDS patients are less likely to receive effective drug treatment, and when they do get it they wait four months longer than patients with insurance. In short, says the report, “uninsured patients have consistently worse clinical outcomes than do insured patients.”

    A survey in 1999, cited in the report, said that almost 60% of Americans believed that uninsured people get the health care they need. “But the evidence refutes this,” said Dr Mary Sue Coleman, of the University of Iowa and co-chairwoman of the committee. “The fact is that the quality and length of life are distinctly different for insured and uninsured populations.”

    Roughly 30 million US adults of working age lack health insurance, although some estimates put the figure at 40 million. Also, about 10 million children lack insurance—a future report will look at this issue.

    The report concludes on a positive note by saying that providing health insurance would result in greater life expectancy, improve the health of people who lack access to health care, and most likely reduce the health disparities among racial and ethnic groups.

    Care Without Coverage: Too Little, Too Late is accessible at

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