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.

Providing patients with promising experimental therapy or ruining clinical trials?

Posted on: October 31, 2009  |   Author: Jessica
Filed Under: Bioethics, Drug & Device   |   Leave a Comment

Ninety percent of clinicians in a recent online survey believed that ignoring certain entry criteria for clinical trials was acceptable if the clinician believes that the patient will benefit from the trial. A number of clinicians described under what circumstances they would bend the rules. Downplaying a substance abuse history, altering medical records, and artificially improving an otherwise poor kidney function test are all examples of protocol violations that some clinicians found acceptable under the right circumstances.

All of the protocol violations were presumably made because the doctors felt that they were acting in the best interests of their individual patients. However, the purpose of clinical trials is not to improve the outcomes of individual patients, they are to determine the safety and effectiveness of an experimental drug or treatment. (To learn more about clinical trials see clinicaltrials.gov)

What does this mean for clinical trials? Do researchers need to focus on improving clinical trial designs so that clinicians do not feel conflicted between their commitment to their patient and the research? If so many clinicians seem willing to break protocol, can the results of the trials even be trusted?

The New York Times, October 29, 2009.

Change in MA law may require Philip Morris to pay for smokers’ cancer screening

Posted on: October 31, 2009  |   Author: Kathryn
Filed Under: Liability & Litigation, Public Health Policy   |   Leave a Comment

A lawsuit against cigarette maker Philip Morris USA may now move forward in US District Court after the Supreme Judicial Court of Massachusetts unanimously decided that the state’s negligence law is antiquated. While plaintiffs have historically had to show explicit injury before a defendant could be required to pay for diagnostic tests, if the jury sides with the plaintiff smokers in this case, Philip Morris could be required to pay for low-dose CT scans to screen for early-stage lung cancer.

The federal court asked the Supreme Judicial Court for a ruling on Massachusetts state law. Writing for the court, Justice Francis X. Spina wrote, “We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury, which should be compensable, even if the full effects are not immediately apparent.”

The federal suit is seeking class certification. If granted, the class would include anyone over fifty who has smoked at least one pack of Marlboros per day for at least twenty years, which would mean thousands of people from Massachusetts. At a cost of $400-500 each, annually, the tests would constitute a major financial blow, according to Edward L. Sweda, Jr., a lawyer with the Tobacco Products Liability Project at Northeastern University.

Philip Morris issued a statement that it wants the case dismissed since other state and federal courts have rejected such class certification of smokers’ claims. According to Murray Garnick, senior vice president and associate general counsel for Altria, “Six of the last seven state supreme courts to consider the issue have refused to recognize claims for medical monitoring based on the risk of future injury.”

Although this ruling could lead to new opportunities for litigation against the tobacco industry, the Supreme Judicial Court specifically stated that it doesn’t automatically apply to other toxic tort suits. It still requires a plaintiff claiming emotional damages to present objective evidence of injury. Also, it does not purport to extend the loss-of-chance theory to toxic tort suits.

Boston Globe, October 20, 2009.

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