The announcement yesterday that patients with public health insurance are more likely to die when they have a heart attack than privately insured patients has serious implications for public policy. On the basis of research undertaken by investigators at Governors State University in Illinois, it is clear that expanding health insurance coverage alone is not enough to stem the death rate of those suffering heart attacks.
Dr. Jie Jay Shen, the lead author of the new study, told The Vindicator that even those who have public health insurance -- like Medicaid -- still have higher mortality rates than those with private insurance because their lower socioeconomic status is a barrier to health resources.
Those with private insurance are more likely to be under the regular care of a physician who knows their health history and will be more likely to call quickly for needed specialists or special procedures. Such is not the case with the lower-income patient whose first contact with health care providers is often at the hospital. "Early detection is very crucial to the ability to survive," Shen said.
Matter of education: Those with lower incomes also tend to have less education, And as Shen explained, "The less educated may not know the earliest symptoms of the disease, and only go to hospital when symptoms are very severe." But, he said, "Then it's too late."
Those patients with their own doctor whom they see regularly are also more likely to be counseled about diet, tobacco consumption or alcohol use -- all risk factors for heart disease and stroke. In Ohio, for example, tobacco use increases as income decreases, and exercise levels decrease as incomes decrease.
While race did not appear as a factor in his study, Shen said that other research has shown that both black and white doctors tend to order fewer specialized tests for their African-American patients who suffer heart attacks. This cannot continue.
To the extent that patients have rights, patients also have responsibilities for their own well-being. In the absence of regular check-ups, a healthy diet, plenty of exercise, reducing alcohol consumption and giving up tobacco can go along way.