TAILIEUCHUNG - Health Insurance And Mortality In US Adults

On the political side, mechanisms for the rapid disbursement of project grants to poor municipalities have an obvious potential for partisan pa- tronage and for political advantage, particularly during election processes. This has to be faced. To reduce the improper management of financial resources, it is critical to adopt transparent and objective selection crite- ria for projects. Additionally, to ensure long-term support for funds by international donors, it is important that technical staff are not treated as political appointees to be changed with each new government | RESEARCH AND PRACTICE Health Insurance and Mortality in US Adults I Andrew P. Wilper MD MPH Steffie Woolhandler MD MPH Karen E. Lasser MD MPH Danny McCormick MD MPH David H. Bor MD and David U. Himmelstein MD The United States stands alone among industrialized nations in not providing health coverage to all of its citizens. Currently 46 million Americans lack health Despite repeated attempts to expand health insurance uninsurance remains commonplace among US adults. Health insurance facilitates access to health care services and helps protect against the high costs of catastrophic illness. Relative to the uninsured insured Americans are more likely to obtain recommended screening and care for chronic conditions2 and are less likely to suffer undiagnosed chronic conditions3 or to receive substandard medical _4 care. Numerous investigators have found an association between uninsurance and The Institute of Medicine IOM estimated that 18 314 Americans aged between 25 and 64 years die annually because of lack of health insurance comparable to deaths because of diabetes stroke or homicide in 2001 among persons aged 25 to 64 The IOM estimate was largely based on a single study by Franks et However these data are now more than 20 years old both medical therapeutics and the demography of the uninsured have changed in the interim. We analyzed data from the Third National Health and Nutrition Examination Survey NHANES III . NHANES III collected data on a representative sample of Americans with vital status follow-up through 2000. Our objective was to evaluate the relationship between uninsurance and death. METHODS The National Center for Health Statistics NCHS conducted NHANES III between 1988 and 1994. The survey combined an interview physical examination and laboratory testing. NHANES III employed a complex sampling design to establish national estimates of disease prevalence among the Objectives. A 1993 study found a 25 higher risk of

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