Uninsured Patients are Not Receiving Equal Care in U.S. Hospitals

In a Washington Post op-ed column, Dr. Manoj Jain paints a troubling picture of inequality in health care among the insured and uninsured in the United States.  He tells the story of a 19-year-old diabetic who lost her health insurance at age 18 and now works two jobs, neither of which provide health insurance.  As a result, she was able to afford insulin only infrequently. 

As mandated by the 1986 Emergency Medical Treatment and Active Labor Act, U.S. hospitals cannot refuse to care for critically ill patients; the physician on call must treat them.  Dr. Jain notes, however, that the treatment provided for insured and uninsured varies greatly.

“It’s not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient’s insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent.

“Some of these adjustments make little difference . . .  .  The impact of other decisions is more worrying. A heart surgeon told me he operates on uninsured patients but schedules them for the end of the day; if other cases take longer than expected, the uninsured get bumped. Some gastroenterologists are quick to perform endoscopies or colonoscopies on insured patients; not so for the uninsured.

Dr. Jain notes that the economics of treating uninsured patients requires inflating the charges of commercially insured patients to a tune of $41 billion dollars, the bulk of which is paid by government.   

If the government is already spending $41 billion on paying for the health care costs of the uninsured in emergency situations where the health care is costly, wouldn’t it make sense to spend that money on less expensive preventative care to avoid over-taxing our hospitals and prevent individuals from suffering through health emergencies?  Read more about the disparate health care treatment, and leave your comments, after the jump.

Dr. Jain referenced a 2007 study by the American Cancer Societythat “showed that patients with no insurance have lower survival rates for breast and colorectal cancer than insured patients” and a 2004 report in Health Affairs that showed that “people ages 51 to 61 with diabetes, hypertension or heart disease had a mortality rate of 12.5 percent over eight years if they had insurance and 18.8 percent if they had no insurance.”  He also notes that:

“[s]ome uninsured patients forgo tests or treatment. According to a 2003 study, participation in screening tests for breast cancer, prostate cancer or high cholesterol was 30 percentage points higher in some instances among people with insurance than among those without. Once the uninsured become eligible for Medicare, that gap shrinks.”

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One Response

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