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Insurance fails to improve outcomes for low-income patients, new study finds


A recent study led by Dr. Paula K. Shireman, School of Medicine, has found that (even with insurance) patients with low socioeconomic backgrounds are more likely to have worse outcomes after surgery. 

Health is influenced by where people live, work and play – social determinants of health. Despite efforts by the health care system, many insurance plans and health care providers struggle to address these factors effectively. 

The Texas A&M study, published in JAMA Surgery, addresses the effects of urgent and elective surgeries as well as serious conditions prior to surgery on surgical outcomes. The study looks at data from nearly 30,000 patients and found that those living in very deprived neighborhoods had lower chances of good outcomes after surgery, even if they had private insurance or Medicare.  

The worse outcomes are linked to how the patients came to the hospital. Patients from poor neighborhoods are more likely to need urgent or emergency surgeries and to also have a serious acute condition before surgery, like pneumonia or acute kidney failure. Presenting with an acute condition and undergoing non-elective surgeries increases the risk of post-surgery complications and worse outcomes. 

The study highlights that while health insurance is important, it is not enough. The researchers suggest that outcomes could be improved if patients have a primary care provider, if low-income patients have waived copays or if policies allow employees to access health care without losing wages. 

Shireman noted that higher presentation acuity (presenting with a serious acute condition or undergoing an urgent or emergent surgery) in patients from deprived neighborhoods may contribute to worse outcomes in safety-net hospitals. This doesn’t necessarily mean that these hospitals provide a lower quality of care. 

“While continuing to improve care in the hospital is important, decreasing presentation acuity, possibly by decreasing barriers to accessing preventive and primary care, may have the greatest impact on improving outcomes,” Shireman said.