Substandard care found for the uninsured No health coverage? Medical errors are called more likely

Uninsured individuals who have to rely on free care at hospitals are more likely to suffer medical injury because of substandard care than patients who have health insurance, a new study has found.

Researchers weren't certain why physicians were more likely to make medical errors in treating patients without insurance coverage. But they said one factor might be that such patients more often receive treatment in emergency rooms, where errors are more common.


A second study showed that uninsured patients also are more likely to be hospitalized for illnesses that could have been prevented or cut short if the individuals had had access to adequate outpatient treatment.

The latter report, a review of hospitalizations in Maryland and Massachusetts in 1987, showed that uninsured patients were hospitalized 50 to 75 percent more often for conditions such as gangrene, heart failure, diabetes and asthma. This suggests, the researchers said, that the uninsured patients' illnesses were more likely to worsen because they weren't being adequately treated until hospitalization was unavoidable.


In short, the medical "safety net" intended to care for the United States' 37 million uninsured is riddled with flaws that are subtle but serious, say the studies in today's issue of the Journal of the American Medical Association.

"In general, there's a disregard for the outcome of care for a lot of these patients," said Dr. Helen Burstin of the Brigham and Women's Hospital and Harvard Medical School, and an author of the report on medical negligence.

"Both studies really point out that the uninsured are not getting the care they need. Clearly we need to change the health care financing system," she said, adding that she would "certainly support" President-elect Bill Clinton's plan over that proposed by President Bush. "It's far more likely to ensure universal access" to adequate health care, she said.

The findings came from an analysis of data from the Harvard Medical Practice Study, headed by Dr. Troyen A. Brennan of the fTC Harvard School of Public Health.

A panel of specialists reviewed 31,429 records of patients treated in 1984 at acute-care hospitals in New York state. It noted cases reflecting substandard results, including those caused by outright negligence. Insured patients (including those on Medicaid) and uninsured patients had the same rate of poor outcomes, but those in which negligence was involved were significantly higher among uninsured patients.

Examples of negligence uncovered by the study included: failing to check X-rays that showed a spinal injury before discharging an auto accident victim; sending a woman home without reading a blood test that would have revealed an ectopic pregnancy; failing to diagnose colon cancer in a woman; neglecting to order a test that would have spotted a blood clot on a patient's brain.

The researchers could not determine whether the physicians knew about patients' insurance status. Nor could they pinpoint why the doctors erred more often in treating uninsured patients. It wasn't that they were visibly different from insured individuals, because race, gender and socioeconomic status were not factors.