Study Finds that Being Uninsured Does Affect Health Outcomes for Children in Hospitals

Posted on: October 31, 2009  |   Author: Asha
Filed Under: Access to Care, HMOs & Health Plans, Healthcare Reform, Insurers/Payors, Other   |   Leave a Comment

The Children’s Center at Johns Hopkins conducted a study including 23 million children from 37 different states between 1988 and 2005. The study showed that uninsured children hospitalizations compared with children having either private or government insurance had a 60 percent higher chance of dying. The study also indicated that at least 1,000 hospitalized children died annually due to a lack of insurance. This means that uninsured children deaths comprise nearly half of all children deaths nationally.

Though the study was not directed at cause, the study also showed that uninsured children are more likely to end up in emergency rooms, where the condition may have worsened by the time care is administered. The time spent in a hospital between insured and uninsured children varied. On average, uninsured children were in the hospital for less than a day when they died. Overall hospitals charges for uninsured children was significantly less than for insured children (less than half).

The author of the study, Dr. Abdullah, did not believe in a causal connection between the amount of care providers gave and insurance status. He noted that children often arrived at the hospital too late for any revival to occur.  These discrepancies are unique because children do not die often. However, nearly seven million children remain uninsured in the United States.  This study helps to show the vast disparate health outcomes that not having insurance can create. According to the Congressional Budget Office, 14 million children will be covered by CHIP by 2013.

Commentary: As the article mentions, such studies help shine light on a moral obligation we face in granting children insurance. Their insurance status is not a choice but a predetermined situation. Uninsured children are more likely to have unmet medical needs, which leads to poorer quality of life. Having such a high number of uninsured children also contributes to overall costs to the health care system, as these children are more likely to end up in emergency rooms where services are expensive and may not be of the highest quality. Thus, it is to the benefit of society overall to keep the number of uninsured children as low as possible

The New York Times, October 30, 2009.

Tough Choices: A Blurb About the Difficult Choices Facing Many Couples in Their Quest for Fertility

Posted on: October 31, 2009  |   Author: David
Filed Under: Drug & Device, HMOs & Health Plans, Health Information, Hospitals & Health Systems, Insurers/Payors, Technology   |   Leave a Comment

It may be one of the hardest decisions an expectant parent would have to make: Reduce the number of fetuses you are carrying or risk losing them all.

Sadly, that is exactly the decision Thomas and Amanda Stansel had to make. After undergoing the popular process of intrauterine insemination in which sperm is injected into Mrs. Stansel’s uterus following hormone injections, Mrs. Stansel received shocking news – she was carrying not one, not two, but six fetuses. However, the Stansel’s excitement was soon crushed when their fertility doctor gave them some additional startling news. Due to the increase in fetuses, the likelihood of delivering six healthy infants was near zero. To save some, he recommended reduction – through a process known as “selective reduction.” The Stansels decided not to reduce, instead relying on their faith to protect them and in August, Mrs. Stansel gave birth to all six babies. Unfortunately, at 14 weeks premature, all weighed in at roughly one pound. The hospital fought valiantly, but three babies died within two weeks. A few months later, another was lost. The two babies remaining continue to struggle, still attached to ventilators and feeding tubes and under constant care in the hospital neonatal intensive care unit.

For couples having difficulties becoming pregnant, there are several options available. First, most doctors recommend utilizing low-potency fertility drugs in order to stimulate the process. If unsuccessful, the next step is intrauterine insemination with hormone injections or in vitro fertilization. This decision is often influenced by two related factors: insurance and costs. The cost of in vitro fertilization costs between $12,000 and $25,000 while intrauterine insemination only costs $2,000 to $3,000 per attempt. As such, many insurance companies will cover multiple rounds of intrauterine insemination before one round of in vitro fertilization. The preference though, is not without drawbacks. Intrauterine insemination, while front-end cheaper, can present significant problems. Excessive hormone injections can lead to an overstimulation of the ovaries which in turn can lead to the increase in probability of having multiples. In fact, the Centers for Disease Control and Prevention supported this theory when it found that the intrauterine insemination process was more likely to result in multiples than in vitro fertilization. And with increased multiples, come increased risks, especially with premature births which carry the risk of long-term complications and disabilities. Multiples, like the Stansel babies, who arrive early, require the highest level of acute care for a longer time than any other patients. This can add up to astronomical financial hardships in the long-run. In addition to money, multiples with increased risks of complications can put families in very difficult decision like the one faced by Thomas and Amanda Stansel- whether to abide by religious beliefs against the perception of abortion or a doctor’s recommendations to reduce.

The current position taken by insurance companies is baffling. Intrauterine insemination is largely undocumented today, but has been shown to be less successful and more dangerous (with respect to increasing risks for premature multiples) than in vitro fertilization. The main upside, cost. Due to the less invasive nature of intrauterine insemination there is a significant cost difference between the two procedures leading many insurance companies to favor the treatment. In doing so, insurance companies may be overlooking two major issues. One, as this procedure becomes more popular, the costs associated with premature multiples will also grow- likely at a much higher rate than the cost of the initial fertility treatment. Second, many couples attempting to start a family do not understand the possible consequences of their actions – the psychological and financial considerations of having a tragic result. Insurance companies have long acted as a gatekeeper in providing medical treatment and should take a second look at their current preference towards intrauterine insemination.

The New York Times, October 11, 2009.

Women Fight for Equality in Health Care

Posted on: October 26, 2009  |   Author: Carmen
Filed Under: Access to Care, Healthcare Reform, Insurers/Payors, Legislation   |   Leave a Comment

An article by Liz Halloran on the NPR website, highlights the disparity in health care coverage between men and women. A recent Women’s Law Center study found that 25-year-old women have been charged up to 84 percent more than their male contemporaries for individual health plans that specifically exclude maternity coverage. The main culprit in premium disparities is an insurance practice known as gender indexing or rating. Already barred in 11 states, indexing is an insurance industry practice that factors in gender as one of many variables used to set insurance premiums.

Many women however do not have the opportunity to pay more for coverage as they are denied coverage simply for being a women. Women are denied coverage by insurance companies citing “pre-existing conditions” that range from having previously given birth by cesarean section to having been a victim of domestic abuse.

Defenders of indexing say factoring in gender is no different than taking into account whether an applicant is a smoker or obese, or has pre-existing medical conditions. The insurance industry has opposed legislation outlawing this practice on the grounds that forcing a “gender neutral” rating scheme would be tantamount to government interference in the market.

However, it appears the federal government may take action to rectify this discrimination as both House and Senate health care proposals being considered would prohibit insurance companies from varying premium cost based on gender and from denying coverage because of pre-existing conditions.

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