Lack of Insurance Hazardous to Health, Hospital Report Shows

If anyone needed documentation for the widely held belief that not having health insurance can be hazardous to your health, the California Office of Statewide Health Planning and Development offers some sobering statistics:

Uninsured patients are 80% more likely to die in California hospitals than those admitted to the hospital with insurance, according to a recently released OSHPD report.

The report also suggests the distinction between private and public health coverage is significant. Patients covered by Medi-Cal, California’s Medicaid program, are 60% more likely to die in the hospital than those with private insurance.

The report, “Mortality in California Hospitals, 2006,” is based on death certificates and other data on all patients hospitalized in the state in 2006. It offers no explanations for the discrepancy in mortality rates based on insurance.

But hospital officials do.

“Both of those speak to access to care,” said Debby Rogers, vice-president of quality and emergency services for the California Hospital Association.

“People who are not in primary care and not receiving appropriate medication, appropriate home care and other treatment outside the hospital are in worse shape when they are admitted,” Rogers said. 

Low Medi-Cal Reimbursement Rates Blamed

California ranks near the bottom in reimbursement rates paid to providers for treating low-income beneficiaries in the federal Medicaid program. Rogers said high mortality rates for uninsured and Medi-Cal patients are related to California’s low reimbursement rates.

“A lot of what we’re seeing in this data is a function of those low rates,” Rogers said.  “It’s very challenging for providers — specialists as well as primary care — to actually care for Medi-Cal patients on an outpatient basis.”

Health advocates argue that low Medi-Cal reimbursement rates ultimately increase the number of uninsured because physicians and clinics stop accepting new Medi-Cal clients, leaving even those who qualify for coverage without insurance.

Although the report’s findings reflect the state’s status two years ago, nothing suggests the situation is much different today.

However, there is reason to believe the situation may change in the coming months and years.

“With the medical cuts and devastating budget we’re facing, we could see higher numbers of uninsured and under-insured in future years,” Rogers said.

OSHPD Avoids Theorizing

OSHPD officials were careful not to offer analysis or theories with their report.

“Our research was based on data that does not tell us why the uninsured or Medi-Cal patients die in hospitals at a higher rate,” said Patrick Sullivan, OSHPD’s assistant director for legislative and public affairs.

“What we know is that based on the 2006 data, it appears that patients with Medi-Cal or no health care insurance are at higher risk of in-hospital mortality.  This report does not explain this finding.  It is possible that this reflects unmeasured differences in severity of illnesses among the uninsured and Medi-Cal recipients,” Sullivan said.

The hospital mortality report, the first of a series of health care briefings based on OSHPD data collection, is meant as a consumer aid, Sullivan said.

“We offer the brief as a description of the current outcomes of hospital care in California,” Sullivan said.  “I think one of the main take-aways is that this type of information helps improve the transparency of the health care system.  It improves consumers’ access to information and makes them more informed about the health care system.”

Examining factors that lead to the higher risk of hospital deaths, the report is part of a statewide effort to improve health care in California through better data reporting and analysis.

“This is about making the system more transparent and improving consumer access to information,” OSHPD director David Carlisle said in a prepared statement. “We hope to help patients and family members become more informed about the health care system and more involved in their health care choices.”

Overall, the report found that 2.1% of California hospital stays resulted in death, compared with 2.5% nationwide.

California’s lower mortality rate can be attributed partly to better access to preventive care for people with private coverage, resulting in patients being in better physical condition when they enter a hospital in California than in other states, OSHPD and hospital officials said.

Leading Cause of Hospital Deaths

Among other findings in the report, the three leading causes of hospital deaths among adults and seniors in California were septicemia, acute respiratory failure and acute cerebrovascular disease. Septicemia, a broad term referring to illness caused by bacteria or other toxins in the blood, was by far the No. 1 killer.

 “We have several patient safety collaboratives working on  septicemia treatment,” said the hospital association’s Rogers.

“We’re focusing on early care for septicemia. Also on pneumonia,” Rogers added. “We’re giving every patient pneumonia vaccine when it’s clinically appropriate.”

The report also dealt with palliative care and end-of-life directives in California hospitals. Rogers said she thinks California hospitals are improving in those areas.

“I think in hospice and palliative care we’re making progress in allowing patients and family members to state their wishes in advance,” Rogers said. “I’m hoping in future years we’ll see more progress in that area.”

What’s Next for OSHPD?

The hospital mortality report is labeled “Brief #1,” leading to the natural question, what will No. 2 be?

“We have various topics under consideration but have yet to finalize them” said Sullivan.

“We are planning to use the feedback from this first brief to help shape that decision.  But, our goal is to ultimately publish at least one a quarter,” Sullivan said.

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