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Uninsured more likely to die in ICU

Monday, May 24th, 2010

In Pennsylvania, hospital intensive care units are less likely to provide some common, and potentially life-saving, treatments to people who are uninsured.

The study from researchers at Penn Medicine also found that patients who are covered by health insurance are less likely to die in the ICU, compared with patients with no coverage.

The research adjusts for varying hospital types and patient characteristics, such as the severity of an illness and still found significant differences in the care provided to uninsured people.

Study author and ICU physician Sarah Lyon says the most concerning explanation is that doctors and hospitals treat uninsured people differently. But her colleagues at the Hospital of the University of Pennsylvania are skeptical of that explanation.

Lyon: The general feeling from everyone is that we really don’t know what a patient’s insurance status is when they come into the intensive care unit. So a lot of people find it hard to believe that they have some personal bias that’s being reflected in the care.

Penn is a large teaching hospital where a patient’s insurance status is more likely unknown by bedside nurses or doctors, but Lyon says that level of anonymity may not hold true at smaller medical centers.

Lyon says researchers should keep looking for explanations.

Lyon: It’s possible that patients who don’t have insurance have preferences or beliefs about health care that lead them to want fewer procedures or less intense care, in the ICU, which may be because of personal beliefs about health care but also may be due to concerns about cost.

Lyon surveyed admissions information from all Pennsylvania ICUs. Uninsured people had worse outcomes across the board, not just at poor-performing hospitals.

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