Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
Disclosures: Drs. Woolhandler and Himmelstein report serving as an unpaid advisors to Bernie Sanders' presidential campaign and were founders of and remain active in Physicians for a National Health Program, an organization that advocates for single-payer reform. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1403.
Requests for Single Reprints: David U. Himmelstein, MD, 255 West 90th Street, New York, NY 10024; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Woolhandler: 255 West 90th Street, New York, NY 10024.
Dr. Himmelstein: 255 West 90th Street, New York, NY 10024.
Author Contributions: Conception and design: S. Woolhandler, D.U. Himmelstein.
Analysis and interpretation of the data: S. Woolhandler, D.U. Himmelstein.
Drafting of the article: S. Woolhandler, D.U. Himmelstein.
Critical revision for important intellectual content: S. Woolhandler, D.U. Himmelstein.
Final approval of the article: S. Woolhandler, D.U. Himmelstein.
Statistical expertise: S. Woolhandler, D.U. Himmelstein.
Collection and assembly of data: S. Woolhandler, D.U. Himmelstein.
About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Patient Protection and Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.
Table 1. Summary of Studies on Relationship Between Insurance Coverage and All-Cause Mortality*
Table 2. Why the Causal Relationship of Health Insurance to Mortality Is Hard to Study
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Michael R. Grey, MD, MPH
Saint Francis Hospital and Medical Center
July 10, 2017
Conflict of Interest:
I was an intern in the same program with Dr. Woolhandler was a junior resident and Dr. Himmelstein a faculty member.
A Report from the Committee of Brutal Facts
“If you look for truth, you may find comfort in the end; if you look for comfort you will not get either comfort or truth only soft soap and wishful thinking to begin, and in the end, despair.” C.S. Lewis
Woolhandler S, Himmelstein DU. The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?. Ann Intern Med. 2017;167:424–431. doi: 10.7326/M17-1403
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Published: Ann Intern Med. 2017;167(6):424-431.
Published at www.annals.org on 27 June 2017
Healthcare Delivery and Policy.
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