Children without health insurance have greater risk of dying, study says

A study from the Johns Hopkins Children's Center indicates that sick children without insurance are much more likely to die in hospitals.

The study, which examined 23 million medical records from a 17-year period, only looked at records after death, making it difficult to discern a causal relationship between lack of health insurance and death risk. Researchers point to the size of the study, though, as evidence that a link between the two is hard to deny.

"We are confident in our finding that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance," said researcher David Chang.

"If you are a child without insurance, if you're seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance," summated lead author Dr. Fizan Abdullah.

Because the study only included deaths after hospitalization, and not deaths post-discharge or in cases where children never visited a hospital, the real risk of mortality in children lacking health insurance may be higher.

Researchers note that insurance coverage did not determine what treatments children received or how long they stayed in the hospital. Dr. Abdullah said, "The children who were uninsured literally died before the hospital could provide them more care." The study determined that uninsured children spent less than a day in the hospital, versus insured children's full-day average.

While the study did not look at factors that led to children's deaths, researchers did notice that the uninsured children were often referred to hospital care after visiting the emergency room. The increased likelihood of ER visits suggests that uninsured children were sicker when they did receive care.

Parents without health insurance are less likely to bring their ill children to primary care physicians, experts surmise. Alison Buist, director of child health at the Children 's Defense Fund, stated that those parents missed opportunities "to get [children] the types of screening and preventive services that prevent" life-threatening disease.

A co-author of the Johns Hopkins study, Dr. Peter Pronovost, commented on the relative rarity of children's deaths. "The striking thing is that children don't often die," he said, adding that "the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue."

Seven million American children are believed to be uninsured. Medicaid provides coverage for low-income children; the State Children's Health Insurance Program was created to cover children who do not qualify for Medicaid. In February, SCHIP was extended to 2013 and expanded. The expansion adds $33 billion in federal funds until 2013. Furthermore, 6.5 million additional children are expected to be covered - and 4.1 million of these would not otherwise have insurance.

The SCHIP extension replaces the current formula of fund allocation with one that adjusts states' CHIP expenditures for inflation and child population growth. And it includes fiscal incentives for states to increase Medicaid rolls by adding eligible low-income children.

Of the uninsured children in the U.S., says the Kaiser Family Foundation, two-thirds are eligible for SCHIP. "Without broader health reform efforts," says the Kaiser Family Foundation, "many children will remain uninsured."

And, as the Johns Hopkins study indicates, health insurance is essential for children. The key difference between insured and uninsured children is that the uninsured group was more likely to seek care once illnesses were serious, suggesting that health insurance enables parents to better maintain youngsters' health.

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Posted: November 2, 2009

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