Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality
Document date: January 08, 2008
Released online: January 08, 2008
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The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. This paper focuses on just one aspect of this harm—namely, greater risk of death—and seeks to illustrate its general order of magnitude.
In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM's methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
As part of the IOM report, the authors sought to estimate the total number of deaths resulting from uninsurance. They began developing this estimate with two long-term, longitudinal studies observing the relationship between insurance status and death rates. One used 1971–87 data on 25- to 74-year-olds from the National Health and Nutrition Examination Survey (Franks, Clancy, and Gold 1993). The other used Current Population Survey (CPS) data on 25- to 64-year-olds from 1982 to 1986 (Sorlie et al 1994). Although the two study populations differed, as did the potentially confounding characteristics for which the researchers controlled, both studies yielded estimates attributing to uninsurance an overall increase of 25 percent in mortality risk for working-age adults.
The IOM study combined this research result with information on the numbers of deaths and the percentages of people who are insured by 10-year age intervals. IOM researchers developed the following formula, which starts with the straightforward proposition that the number of total deaths in an age group is the sum of (a) deaths among insured members of that age group and (b) deaths among uninsured members of that age group.Note that DU, or the number of deaths among the uninsured, is calculated through two steps. First, the IOM methodology ascertains the number of deaths among the uninsured as if everyone in the age cohort had insurance. That number is X (or the total number of deaths if everyone in the age cohort had insurance) times PU (or the proportion of people in the age cohort who lack insurance). Second, the number of deaths as if the uninsured had insurance is multiplied by 1.25. This yields an estimate of the actual number of deaths among the uninsured, reflecting the 25 percent higher mortality rate among the uninsured found by the above-described research.
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