Health insurance doesn’t guarantee good surgical outcomes for impoverished communities

Insurance coverage alone is not enough to have better health outcomes for people living in poor neighborhoods. A recent study from Texas A&M University School of Medicine found that even with insurance, patients in these areas were more likely to have worse outcomes after surgery.

Health is influenced by where people live, work and play. These factors, called social determinants of health, can affect a person’s well-being. Despite efforts by the health care system, many insurance plans and health care providers struggle to address these factors effectively.

Previous studies on surgical outcomes have not distinguished between urgent and elective surgeries or considered serious conditions before surgery. This Texas A&M study, published in JAMA Surgery, aimed to address these gaps.

Paula K. Shireman, MD, who led the study, suggests that focusing on preventive care could improve surgical outcomes for people with low socioeconomic status.

The study looked at 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 were linked to how the patients came to the hospital. Patients from poor neighborhoods were 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, and if policies allow employees to access health care without losing wages.

Shireman notes 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 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.