In-Hospital Mortality Rates Higher for the Uninsured

Patients who are uninsured or on Medicaid are more likely to die in the hospital when being treated for heart attack, stroke, or pneumonia, a new study finds.

Researchers examined 154,381 discharges with one of those three diagnoses, and compared in-hospital mortality, length of stay, and cost-per-hospitalization for Medicaid and uninsured patients with the privately insured. The data revealed that, compared to privately-insured patients, uninsured patients had 52% higher odds of dying in the hospital after a heart attack and 47% higher odds of dying in the hospital after a stroke. Among pneumonia patients, the odds of mortality were 21% higher for those on Medicaid.

Length of stay was also significantly longer for Medicaid and uninsured patients for all three conditions.

The higher mortality and LOS rates may be stem in part from uninsured patients' lack of access to primary care and preventive services, says lead researcher Omar Hasan, MBBS, MPH, instructor at Harvard Medical School and hospitalist at Brigham & Women's Hospital in Boston. Uninsured patients are likely to have more severe disease, which could account for higher mortality, he says.

But the quality of hospital care may also be a factor. Other studies have shown that hospitals are less likely to utilize invasive and potentially life-saving interventions on the uninsured, says Hasan. For example, an uninsured patient with acute myocardial infarction may be less likely to be treated with coronoary angiography than a privately insured counterpart.

Previous research cited by the authors also suggests uninsured patients may actually have a higher risk of receiving substandard care.

"These disparities are the result of several factors. It's not just one particular thing.," says Hasan. "We can't quantify exactly what factor contributes how much."

What can a hospital do to address the disparity and close the gap between the insured and uninsured? The first step is to start collecting and analyzing better data to recognize the gap in care at the hospital level, says Hasan.

"The fact that we found these differences . . . suggests that not everyone is getting the care they need, that there is disparity based on insurance," he says. "I think we could do a better job by providing evidence based care to everyone who walks in the door."