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Uninsured Die At Higher Rates After Brain Surgery, Study Finds

By Alvin Tran

November 20th, 2012, 5:56 AM

Your chances of surviving brain surgery might be affected by whether you have health insurance.

According to the findings of a new study by Johns Hopkins University researchers, uninsured patients died at a higher rate after receiving brain surgery to remove cancerous tumors than those with private insurance. Uninsured patients had a death rate of 2.6 percent, compared to 1.3 percent among the privately insured, a statistically significant difference.

“If you have some type of insurance, you’re going to do better,” said Dr. Alfredo Quiñones-Hinojosa, the study’s lead researcher, adding that survival rates for patients covered by Medicaid were slightly better than those for the uninsured, but the difference was not significant.

In the study, published this week in the Archives of Surgery, researchers reviewed the records of more than 28,000 patients and compared their in-hospital death rates based on insurance status. The study isn’t the first to link health insurance status to health outcomes. Previous research has documented the same pattern  among patients undergoing surgeries for other conditions, including cardiovascular disease.

But the factors causing uninsured patients to do worse aren’t entirely understood. “Whether we like it or not, this paper raises more questions than it answers,” Quiñones-Hinojosa said.

Researchers looked at several possibilities that could explain the study’s findings.

Previous research suggested that being uninsured may influence a patient’s overall health and ability to access care. The study was unable to address whether uninsured patients had undiagnosed medical conditions that might have contributed to their poorer outcomes, however.

Researchers also speculated that doctors may treat the uninsured differently. Quiñones-Hinojosa said he would like to conduct a future study that would follow surgical patients and analyze the care they receive. As for the higher death rates of Medicaid patients, Quiñones-Hinojosa suggested that one factor may be that doctors generally do not think highly of the federal-state program for the uninsured.

Quiñones-Hinojosa declined to offer an opinion about whether the expansion of coverage expected to take place in 2014 under the 2010 health care law, including an expansion of Medicaid, would improve health outcomes.

“This paper argues that patients with some sort of insurance don’t die as much [as those] without insurance,” he said. “One can logically ask … will having some sort of universal coverage lead to something in favor of patients not dying?”

13 Responses to “Uninsured Die At Higher Rates After Brain Surgery, Study Finds”

  1. ken says:

    A hundred years from now, anthropologists will study the early 21st century and they will wonder why our society was so barbaric to certain segments of the population to allow these segments to die simply because they are poor. These future scientists will study the behavior of our political leaders and ponder the question of how they could possibly be so cruel to the least fortunate of our society while the wealth and power of the most fortunate 1 percent of our society was so well segregated and well protected. The very least that the wealthy 1 percent could do is to command their Congressional Republican water-coolies to make assisted suicide free and legal so as to ease their lingering pain, huh?

  2. This is not about insurance (or uninsurance). It’s about poor socioeconomic status. Yes, mortality was increased among the uninsured by 100% with comorbidities and by 160% without comorbidities, but for those who were insured by Medicaid, mortality was increased about 80% as much, to 77% without comorbidities and 130% with comorbidities. Insurance is important, but the big culprit here is poor socioeconomic status.

  3. steve b. says:

    The big picture? It’s about the rapidly growing divide between the haves versus the have nots. It’s all about decades of the wealthy stacking the deck against those with the “poor socioeconomic status”. FACT: Money buys power. Those with the most money buy the cards they get dealt. They buy Congress. The eventual solution? FACT: Money doesn’t buy votes. When one side has 1 percent of the troops and the other side had 99 percent of the troops, guess which side will eventually win the war? It’s called demographic creep. We saw the first signs of demographic creep on November 6th, 2012. By the time 2014 rolls around, demographic creep will have increased significantly. By 2016, demographic creep will make certain that some political parties become irrelevant. Get the picture, Mr. Comorbidity?

  4. paula says:

    In my opinion, Steve is correct. The game is changing. In the recent election we watched as a few very wealthy individuals tried to buy a President and a Vice President for their very own. Much like going to the pet shop and buying a puppy. Guess what? Those wealthy individuals got a rude awakening! In spite of Supreme Court Justice Sam Alito’s best effort to put the election for auction to the highest bidder, voters fought back and matched these wealthy slugs dollar for dollar. My $5 here and my $10 there, multiplied by millions upon millions of middle-class voters, fought Justice Alito and his billionaire buddies and we pushed President Obama over the finish line and helped him get re-elected. The game has changed for as far into the future as we can see. Demographics will sink the Republican party because they are not relevant and they refuse to allow brown people into their exclusive tent. In the recent election, Republicans have shown that they hate brown people, most of which are currently uninsured and are dying from many diseases as a result. With Voter ID laws, long waits at the polls, eliminating early voting, redistricting and many other means of voter suppression, the GOP has proven that they want keep brown people away from the voting booth. We need only look at Florida as a perfect example of such voter suppression. NEWS FLASH: The GOP can’t keep us from voting! We will do everything possible to cast our vote and when we vote, our vote will not be for Republicans who hate us.

  5. Tammy says:

    Hello Steve and Paula! As a healthcare provider I suggest you wake up and smell the coffee. I can assure you that nurses and physicians do not typically know who the insured and uninsured are – they simply provide the best care possible to each and every patient. As Buz so eloquently states, a low socioeconomic level is typically linked to overall poorer health. I will go a step further and suggest that we need to teach our citizens to help themselves – doctors and nurses can only do so much without individuals taking responsibility for making healthy choices to optimize their wellbeing. Having studied the affordable care act pretty extensively all I can say is hang on to your hats – although there are wonderful elements of the bill, a bulk of it is unfunded, will jeopardize hospitals, drive physicians out of healthcare, and likely not improve the quality of care.
    P.S. Paula – nobody hates you. The republicans are voting to preserve the individual freedoms that our forefathers fought so hard to gain. So lose the arrogance – this is not about you, it is about a way of life and fighting to save a country so great that immigrants continue to clammer to get here. I am an independent who votes with my heart, not along party lines, but even I understand that we are at a crossroads in the U.S. Stop with the racist rhetoric – it serves no purpose but to further divide our people and we need to join together to stop the insidious disintegration our country.

  6. rick says:

    I’m with Steve and Paula…

    “a low socioeconomic level is typically linked to overall poorer health”. Huh? Gee, did a degree from Harvard give you the thinking skills required to figure that one out? Maybe if these “low socioeconomic level” people could afford to see a doctor or a nurse once in a while, maybe they could be taught the skills necessary to, as you say, help themselves, huh? Some folks don’t get it because some folks simply don’t have those problems, right? Some folks get to see their concierge doctor in his/her opulent designer office any time they please because they got lucky and work for a Fortune 500 company. Not true with someone who flips burgers all day for a living. Not true for someone who empties the office trash can or mops the floor or watches your kids all day while you are at work. Fact is, not everyone has the money for health insurance to see a nurse or a doctor anytime they get the flu or need a wart removed or are worried about the lump that they feel in their breast. You see, some people simply don’t have a clue how poor people exist. Some people are too busy wrapping themselves in the American flag and spouting scripture from a pocket-sized copy of the Constitution they carry around with them everywhere they go. FACT: 50 million Americans have no healthcare insurance! FACT: An estimated 25 million Americans are underinsured! FACT: Those 75 million people, one quarter of the population, simply get their primary care at the hospital ER! Yet, how can we expect certain privileged “insured” people to understand? Maybe they’ve got themselves wrapped too tight in the American flag that they insist on wearing? Those 50 million uninsured people? Those 25 million underinsured people? They are a “huge” problem that needs to be dealt with. It is the sigle-most reason our healthcare sysem costs so much. The ACA begins to address that problem! It gets people insured and into a vast risk pool. Any person in the insurance business knows that the bigger the risk pool, the lower the cost for everyone. Only a moron thinks otherwise. Nothing the GOP has in their bag of policies comes anywhere near solving the uninsured and underinsured problem. Left to Republicans, healthcare in America lets the “low socioeconomic level” people simply go to the hospital ER when they get sick, use up all of the hospital resources and then walk out without paying. The Republican solution is, don’t get sick! But if you do get sick, die early!

  7. salvadore g. says:

    “Having studied the affordable care act pretty extensively all I can say is hang on to your hats – although there are wonderful elements of the bill, a bulk of it is unfunded, will jeopardize hospitals, drive physicians out of healthcare, and likely not improve the quality of care.”

    If you read the law, you would not be saying what you say. Obamacare is our only hope of ending a broken fee-for-servce system that rewards nothing but the volume of procedures and the prescribing more and more medicine. In a fee-for-service model, the only people getting any benefits are the providers, the medical device makers and Big Pharma. The patient gets absolutely no benefits. After treatment, the consumer is lucky to be alive! Every other industry is held accountable. My auto mechanic had better fix my car, or he doesn’t get paid. A doctor? They get paid even when their patient dies! Show me any other industry that can do that and get away with it? The best thing to happen as a result of Obamacare is that solo doctors, the Marcus Welby types, will dry up and blow away as more and more ACO’s form. The good part is, the ACO’s will not hire any quacks! Once a doctor screws up, he’s done! He’ll never practice again under Obamacare’s performance based system. Obamacare will weed out the quacks and put an end to their careers. Do yourself a favor. When you say you “studied” the new health care reform law, why don’t you at least read it?

  8. Kevin says:

    Sad, but likely multifactorial problem. Patients without insurance often present with more advanced tumors because they could not get access or denied their symptoms to avoid cost of evaluation. Our healthcare system needs changes and we will see how far the ACA goes. Some of it boils down to our ability to fund adequate care for the majority and the willingness of the country to prioritize access for all. Medical care is expensive, even if all the cost cutting maneuvers work out. Do we as a nation have the heart to ride out the changes and inconvenience that will come with greater access for all? I hope so, but there will be some bumpy days ahead.
    The Republicans need an extreme makeover. They are trying to hold back progress and fairness which is not possible. As an Independent, I don’t have a dog in the political fight but trying to stop Americans from voting is a doomed strategy. The President has issues also but, he at least comes off as compassionate.

  9. Tony says:

    I’ve been selling insurance for over 45 years. All types of insurance from life to home to car to flood, you name it, I’ve sold it. The one thing any insurance person will tell you is, the higher number of people you have in the risk pool, the lower the premiums will be for the entire pool. That is true regardless of which type of insurance you are talking about. It all works the same way. Obamacare will work! Why? Because Obamacare brings at least 30 million new insurance customers into the market. That coupled with opening up exchanges in every state to increase competition, it’s a no brainier! Obamacare is a natural. It can’t fail. The potential is even greater because there’s another 20 million more customers out there that could be drawn into the exchanges making Obamacare the best thing since sliced bread. Obamacare will work. There is no doubt about it! Take it from someone who knows.

  10. salvadore g. says:

    Tony,

    The problem I’m hearing is that health insurers, especially the smaller health insurers, will not be able to gear up in time for the massive influx of new customers by 2014. Insurance companies have been watching and waiting so long for voters to elect Romney with his promise to repeal Obamacare, now that Romney lost and repeal is out of the question, they find themselves not prepared to manage all of the new business by 2014. Absolutely, it will be a windfall for the insurance companies! My guess is, insurance companies will struggle to keep up and competition will be fierce for a while. When the dust settles, we will see that the consumer will be the overall winner. When you are dealing with 30 million new customers in a relatively short period of time, it’s like the biggest Black Friday nightmare we’ve ever seen!

  11. Yolanda says:

    “The republicans are voting to preserve the individual freedoms that our forefathers fought so hard to gain.’

    Gee Tammy, help me understand…

    Maybe you are talking about the individual freedoms that our forefathers wrote about in our founding documents while they owned slaves and bought and sold black people as if they were common property? Those forefathers? Are you talking about the same forefathers that denied the right to vote unless you were a land owner? Huh? Are you talking about the same forefathers that denied women the right to vote until the early years of the 20th century? Huh? Are they the wonderful forefathers you are talking about?

  12. Yolanda says:

    “…although there are wonderful elements of the bill, a bulk of it is unfunded, will jeopardize hospitals, drive physicians out of healthcare, and likely not improve the quality of care.”

    Do no harm to the providers (hospitals, doctors and big pharma) but it’s okay to screw the consumer as much as you want, right? These corrupt shysters have had it far too good for far too long!

    Oh, and by the way, in case you haven’t studied it completely, Obamacare is fully funded! Unlike the unfunded Bush Tax Cuts (2001 & 2003) which went on the nation’s credit card. The two unfunded wars that Bush started (Afghanistan & Iraq) which went on the nation’s credit card, and an unfunded Medicare Part D program that Bush signed into law. Please, don’t talk about Republicans being fiscally conservative. Using the words fiscally conservative and Republican in the same context is an oxymoron.

  13. Lance says:

    “Uninsured Die At Higher Rates After Brain Surgery, Study Finds”

    As a card carrying member of the tea party I say…

    Good riddance!

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