Lack of health insurance tied to child deaths

NEW YORK (Reuters Health) - Hospitalized children who lack health insurance are more likely to die than those who have coverage, a large U.S. study finds.

Using data on more than 23 million child hospitalizations between 1988 and 2005, researchers found that children without insurance were 60 percent more likely to die than those with either private or government insurance coverage.

They estimate that lack of insurance directly contributed to nearly 17,000 children’s deaths over 18 years.

The findings, reported in the Journal of Public Health, do not prove cause-and-effect. But the increased risk was there even after the researchers accounted for demographics like race and neighborhood income levels, as well as the child’s diagnosis and any co-existing health problems.

The results also suggest that “pre-hospital factors,” at least some of which could be related to lack of insurance, account for the higher risk of death, explained lead researcher Dr. Fizan Abdullah, an assistant professor of pediatric surgery at Johns Hopkins Children’s Center in Baltimore.

Looking at all deaths during the study period, the researchers found “striking differences” in the length of stay and hospital charges for insured and uninsured children, Abdullah told Reuters Health.

On average, insured children’s charges totaled roughly $21,000, while uninsured children averaged $8,000. And while uninsured children were typically in the hospital less than one day, those with insurance were there for a full day.

But this is not, Abdullah said, because hospitals were refusing to treat the uninsured children.

He and his colleagues found no large differences in hospital charges and length of stay among insured and uninsured children who survived their hospitalization.

Instead, uninsured children who died likely got to the hospital later than their insured counterparts, after their condition had deteriorated significantly. “These kids died before the hospitals could provide medical care,” Abdullah said. “They literally never had a chance to treat them.”

It’s possible, the researcher speculated, that financial barriers came into play -- if, for instance, parents had no regular pediatrician they could consult, or waited to take their child to the hospital because they had no way of paying.

The findings are based on data for 23.5 million pediatric hospitalizations in 37 U.S. states between 1988 and 2005; 95 percent of children were insured through either private or government plans, while the rest were uninsured.

Of insured children, 0.47 percent died in the hospital. That figure was 0.75 percent among children without insurance.

The researchers performed a statistical simulation to estimate how many deaths among uninsured children might have been prevented by insurance coverage. They say that nationwide, 16,787 children might have survived if they’d had coverage.

“It’s sad,” Abdullah said. “We are a wealthy country, we have the resources. But we haven’t taken care of this vulnerable part of our population.”

Earlier this year, the federal government expanded the State Children’s Health Insurance, or SCHIP, to cover an additional 3.5 million of the nation’s uninsured children. The program is intended to help working families with incomes too high to qualify for Medicaid; each state designs its own SCHIP program, including eligibility criteria and the benefits provided.

“We are making progress,” Abdullah said. However, he argued, “our policymakers should start from the premise of, how do we insure every child?”

SOURCE: Journal of Public Health, October 30, 2009.