Uninsured May Not Get

Timely Follow-Up Care

It is not how sick you are but whether you have health insurance that often determines how quickly you can get urgently needed follow-up care after emergency room treatment, a study found.

Patients with private insurance have a far better chance of getting appointments within a week of treatment than those on Medicaid or with no insurance, according to the study of 430 clinics in nine U.S. cities. Most clinics inquired about patients' insurance status but not their condition, the researchers found.

The findings shatter the myth that "when people really need care, they get it," said lead author Brent Asplin, head of emergency medicine at Regions Hospital in St. Paul, Minn.

In the study, described in today's Journal of the American Medical Association, graduate students posed as patients treated in emergency rooms for pneumonia, rising high blood pressure or suspected tubal pregnancies.

The students called clinics saying they had been treated the previous night and had been urged to obtain follow-up care as soon as possible.

"Privately insured" callers were much more likely to get timely appointments than those posing as Medicaid patients -- nearly 64 percent vs. 34 percent -- and than those posing as uninsured patients -- 65 percent vs. 25 percent.

U.S. Death Rate Down

32 Percent Since 1970

Better treatments for chronic illnesses such as heart disease and cancer have led to a 32 percent drop in the U.S. death rate since 1970, but Americans face increasing threats from obesity and smoking, a study said yesterday.

An American Cancer Society analysis of annual U.S. mortality rates found deaths from all causes declined from 1,242 deaths per 100,000 in 1970 to 845 per 100,000 people in 2002.

The look at six leading causes of death found mortality rates over three decades declined 63 percent for stroke, 52 percent for heart disease, 41 percent for accidents and 3 percent for cancer. But the death rate from chronic lung disease doubled, and the rate for diabetes rose 45 percent, an outgrowth of an aging population that smoked and rising rates of obesity.

The decline in death rates from stroke and accidents has slowed since the early 1990s, wrote study author Ahmedin Jemal, citing the relaxation of highway speed limits for the latter.

For Overweight People,

Blood Pressure Is Key

Scientists studying nearly 250,000 people in France found that only overweight people who also had high blood pressure were at significantly greater risk of dying of heart-related problems than normal-weight people. Overweight people with normal blood pressure faced no increased risk.

This does not mean that extra pounds are not dangerous, because overweight people are more likely to develop high blood pressure.

But it does for the first time show that blood pressure may be an important "mediator," or mechanism by which excess weight can cause heart problems, said one expert who reviewed the work, Frank Hu of the Harvard School of Public Health.

The study, published yesterday in Hypertension: Journal of the American Heart Association, was led by Frederique Thomas at the Medical School of Nancy and involved 139,562 men and 104,236 women who had routine health checkups at a clinic in Paris from 1972 to 1988.

-- From News Services