Earlier this month I looked at outcome differences in insured and uninsured patients at an urban Level I trauma center. A study published last month looked at a similar type of trauma center but focused only on penetrating trauma. Guess what? Same result.

This study was a lengthy (10 year) retrospective look at only patients who sustained gunshot wounds. Only one fourth of the patients had insurance. The in-hospital mortality was 50% higher for uninsured vs insured patients (9% vs 6%). There was no difference in injury severity, and the mortality difference persisted after controlling for age, gender, race and injury severity.

Interestingly, in this study there was no difference in imaging or operative intervention like there was in the LA study.

Once again, it looks like insurance status does make a difference. There are three possible factors: differences in access to care, physiologic differences, and differences in socioeconomic backgrounds. Access in this case was equal regardless of insurance status, and physiologic differences were minimal. That leaves us with socioeconomic differences. These social factors can lead to baseline differences in health which may have an impact on outcome. 

The results of this study and the one I previously commented on will become even more interesting as healthcare coverage legislation is phased in over the next few years. The hope is that mortality rates for insured and uninsured will begin to equalize over the following years. The reality may be that it will take longer than we expect due to the time and effort needed to change basic human behavior.