Fwd: qotd: Uninsured have higher mortality after surgery for brain tumors

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-------- Original Message --------
Subject: qotd: Uninsured have higher mortality after surgery for brain
tumors
Date: Tue, 20 Nov 2012 10:36:30 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Archives of Surgery
November 2012
Postoperative Mortality After Surgery for Brain Tumors by Patient
Insurance Status in the United States
By Eric N. Momin, MD; Hadie Adams, MD; Russell T. Shinohara, PhD;
Constantine Frangakis, PhD; Henry Brem, MD; Alfredo Quiñones-Hinojosa, MD

Among patients with brain tumors with no other major medical condition,
uninsured patients (but not necessarily Medicaid recipients) have higher
in-hospital mortality than privately insured patients, a disparity that
was pronounced in teaching hospitals. These findings further reinforce
prior data indicating insurance-related disparities in medical and
surgical settings.

These insurance-related disparities might be explained by 1 of 3
possible mechanisms. Insurance status could influence health outcomes by
affecting (1) a patient's overall state of health, (2) the ability to
access care (affecting the acuity of disease presentation), or (3) the
quality of treatment that is provided.

Insurance-related disparities are not unique to the field of
neurosurgery. Uninsured patients fare worse than privately insured
patients in the settings of critical illness (higher chance of having
life support withdrawn), ischemic or hemorrhagic stroke (higher
mortality and neurologic impairment), myocardial infarction (higher
mortality), and physical trauma (higher mortality). However, it is not
clear that enrolling in a state-funded health plan would help the
uninsured because Medicaid recipients also seem to experience a similar
disparity in other settings, including pneumonia, appendicitis,
abdominal aortic aneurysm repair, limb-threatening ischemia, and surgery
for colorectal carcinoma. Of note, this Medicaid disparity was also
present in our full cohort but was not convincingly present in the
adjusted analysis of patients with no comorbid disease, especially in
teaching hospitals.

http://archsurg.jamanetwork.com/article.aspx?articleid=1392156


Comment: Uninsured patients operated on for brain tumors have a higher
in-hospital mortality than do insured patients. Regardless of the
reasons why, this study adds to the abundance of studies that
demonstrate that being uninsured can be bad for your health. Even
patients with Medicaid may experience similar adverse outcomes.

The Affordable Care Act will leave 30 million uninsured, and it relies
partially on Medicaid to expand coverage. Thus the Affordable Care Act
may still be bad for the health of many of us.

We need a single program that provides all of us with high quality care
- an improved Medicare for all. We should not put up with a deficient
health care program that leaves some of us sick or even dead.