Study Challenges Notion that Uninsured Are Covered by Safety Net
Many members of the uninsured in the US population go without proper medical attention—failed by a safety net that has been touted as serving their needs, said Harvard Medical School researchers in a study published in the October 25, 2000, issue of JAMA (2000;284:2061–2069).
“Many uninsured adults are going without proper medical attention,” said the study’s lead author, John Ayanian, MD, MPP, associate professor of medicine and healthcare policy at Harvard Medical School and Brigham and Women’s Hospital. “Thirty-two percent of women without health insurance for more than a year report not getting a mammogram in the past 2 years. Twenty-six percent of the long-term uninsured with hypertension or diabetes said they haven’t had a check-up with a doctor in 2 years. From a public health perspective, these numbers are very concerning.”
The Harvard group found that 14% of 220 000 adults aged 18 through 64 years who were surveyed between 1997 and 1998 reported lacking health insurance, and almost 10% reported being without health insurance for at least a year. The survey was structured to approximate the demographics of the 163 million US adults living in households with telephones. The survey was part of the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System.
Nearly two-fifths of the adults in the long-term uninsured group and one-third of those in the short-term uninsured group reported not being able to see a physician during the past year because of cost. Cost barriers were highest for those in poor health; 69.1% of the long-term uninsured and 52% of the short-term uninsured who had health problems said they could not see a physician in the past year because they lacked the funds to pay for the visit.
“Studies such as this one prove that living without insurance is a serious health risk that needs to be treated with the same sense of urgency as not wearing seatbelts or drunk driving,” said Sandra Adamson Fryhofer, president of the American College of Physicians–American Society of Internal Medicine, the group that funded the study.
Despite these statistics, the Harvard researchers said studies indicate that a growing portion of the US populace believe that uninsured people can get the health care they need from physicians and hospitals that are part of the nation’s safety net. In 1993, 43% of the population believed that people got care without regard to insurance status. By 1999, the percentage had increased to 57%.
Medical School Applications Continue Drop but Still Outnumber Positions
More than 37 000 would-be physicians applied to US medical schools for the 2000–2001 school year—a 3.6% decrease from the number of applicants for the previous year. However, said Jordan J. Cohen, MD, president of the Association of American Medical Colleges, the figure remains more than double the number of open positions.
The figures, which were released in Washington, DC, on October 25, 2000, reflect a continuing decrease in applicants. In 1996, the number of applicants to medical schools totaled 46 968; thus, the number of applicants has declined nearly 25% in the past 4 years.
However, Dr Cohen said that grade point averages and scores on standardized tests have remained high, indicating that the quality of the applicant pool remains excellent. The Association of American Medical Colleges attributes the drop in applicants to the following:
A strong economy
Concern about accruing high levels of educational debt
A perceived loss of freedom to practice in a healthcare environment dominated by managed care
Lancet Study Disputes Existence of “Economy Class Syndrome”
A study in the October 28, 2000, issue of The Lancet disputes the notion that people who sit in the cramped quarters of an airplane’s economy class face an increased risk of deep vein thrombosis, also known as “economy class syndrome” (Lancet. 2000;356:1492–1493). The research from Roderick Kraajenhagen, MD, and colleagues at the University of Amsterdam in the Netherlands appeared at virtually the same time that news reports appeared in Britain regarding a 28-year-old woman who died of deep vein thrombosis after a 20-hour flight from London, muddying the picture of the problem.
In their study, the Dutch scientists compared the travel histories of 788 patients with venous thrombosis to that of patients with similar symptoms who did not have deep vein thrombosis. In this study, they found the risk of developing the disease among air travelers to be the same as that of people who did not travel by airplane. The risks remained the same, even when the duration of the travel was taken into account.
In their report, the researchers noted, “These results do not lend support to the widely accepted assumption that long traveling time is a risk factor of venous thrombosis. Even for journeys lasting >5 hours, no association was apparent.”
Bicyclists Saved by Helmets
The percentage of British bicyclists hospitalized with head injuries dropped 24% between 1991 and 1995, a period during which officials and physicians were urging cyclists to wear helmets. “Our findings indicate that cycle helmets are of benefit both to children and, contrary to popular belief, to adults,” wrote the authors, who were led by Adrian Cook, a statistician in the Department of Primary Health Care and General Practice at the Imperial College School of Medicine in London (BMJ. 2000;321:1055). On a monthly basis, the percentage of cyclists admitted with head injuries dropped from 40% of the total cyclist admissions to 28%.
The decrease occurred in each age group during the period studied. The study’s authors suggested that as cycling increases with government encouragement, publicity campaigns to promote helmet use should become a mainstay in the program to promote physical exercise.
It’s the Birds
Common house sparrows may serve as a reservoir host for West Nile virus, an infection newly emerging in the United States, said Nicholas Komar, MD, a researcher with the Arbovirus Disease Branch of the federal Centers for Disease Control and Prevention in Fort Collins, Co.
Reservoir hosts carry the virus without being killed by it, Dr Komar told attendees at the annual meeting of the American Society of Tropical Medicine and Hygiene in Houston, Texas, on October 29, 2000. The sparrows carry the virus, which is acquired from them by mosquitoes, who then pass it on to humans.
Suspecting that birds were a reservoir for this mosquito-borne virus as they were for other viral diseases, Dr Komar and his colleagues exposed different species of wild birds to bites from mosquitoes carrying the strain of the West Nile virus current in New York. Most birds survived initial infection with the virus and developed neutralizing antibodies. House sparrows developed the highest levels of circulating West Nile virus and had the longest viremia. Dr Komar said the sparrows are probably not involved in transporting the virus because they do not migrate. However, they can harbor the virus, allowing it to multiply in their bodies.
- Copyright © 2000 by American Heart Association