Confronting Insurance Coverage as a Risk Factor in Hospital Mortality Rates

Michael Usher, MD, PhD, was recently published in the Journal of General Internal Medicine for his research on, Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study.

This research seeks to identify the relationship between insurance coverage and the mortality rate of patients transferred between hospitals. 

“What we found was that patients without insurance are more likely to be transferred from the emergency department or earlier in the admission, and had higher mortality.” Dr. Usher says these results are in line with other studies demonstrating that uninsured patients are at higher risk of adverse events.

This study demonstrates how patients will receive expensive care regardless of their insurance status. Dr. Usher explains how one reason for this might be the fact that uninsured patients who lack preventative care are not admitted to the hospital until they have an emergent condition. Alternatively, hospitals could be providing patients with a mandated triage exam and then transferring them to another hospital for financial reasons.

“This study was not designed to sort out which cause was most likely” Dr. Usher goes on to claim that the real risk factor does not come from why these patients are being transferred, but rather from patients being uninsured in the first place.

In addition, Dr. Usher’s research found that there is a disproportionate number of these transferred patients ending up in government hospitals.

“This highlights the fact that having uninsured patients just doesn’t make sense: the cost of care remains even if it gets pushed around, and uninsured patients experience real harm.” Uninsured patients could potentially be increasing costs in the end because most are not seeking help until their health conditions have gone too far.

Moving forward, Dr. Usher hopes to focus on the impact of fragmentation of these vulnerable patients. “The next steps are really seeing if Medicaid expansion and reducing the rate of uninsured really had a positive impact on this population.”

This study was successful in highlighting the fact that Emergency Medical Treatment and Labor Act is not sufficient to protect uninsured patients, since it does not address the underlying problem. With the work that Dr. Usher put into this research, his hope is that these findings will produce results that lower risk factors for patients and provide equitable health coverage for all. 

For more on Dr. Usher’s work, read the full studyPDF icon here.

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