Wednesday, September 23, 2009

Health Affairs Blog

45000 premature deaths a year due to lack of insurance?

t begins with a paper by Peter Franks et al. published in the Journal of the American Medical Association in 1993, estimating that being uninsured increased the probability of death by 25%. Although the subjects were interviewed only once, for the study's inference to be meaningful, one is forced to make the unverified assumption that the uninsured stayed uninsured for a full 19 years!

Continuing the saga, the Institute of Medicine (IOM) uncritically used the Franks result to claim that 18,000 deaths a year in the U.S. are attributable to a lack of health insurance. The Urban Institute updated the IOM report, and Families USA updated the Urban Institute report.
Not to be outdone, Physicians for a National Health Program (PNHP) has just repeated the exercise (with all its methodological sins) and boosted the tally to a 40% increase in the probability of dying for the uninsured. That produces a whopping 45,000 premature deaths every year – almost as bad as the Vietnam War. And, yes, we get a state-by-state breakdown. There will be 5,302 deaths attributed to uninsurance in California this year. There will be 75 in Wyoming, etc., etc. There is even a minute-by-minute tally: "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance," says David Himmelstein, one of the authors. "Now one dies every 12 minutes."

As in the previous incarnations, the researchers interviewed the uninsured only once – and never saw them again. A decade later, the researchers assumed the participants were still uninsured and, if they died in the interim, lack of insurance was blamed as one of the causes.

Yet, like unemployment, uninsurance happens to many people for short periods of time. Most people who are uninsured regain insurance within one year. The authors of the PNHP study did not track what happened to the insurance status of the subjects over the decade examined, what medical care they received or even the causes of their deaths.

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