American patients who undergo lung transplantation for cystic fibrosis have much poorer survival if they are publicly insured, compared with UK patients who are publicly insured. This is according to a new study published in the American Journal of Transplantation.
Approximately 30,000 children and adults in the US have cystic fibrosis (CF) – an inherited condition in which the lungs and the digestive system become blocked with thick, sticky mucus.
People with CF can experience repeated and severe lung infections, malnutrition, difficulty breathing and premature death.
While some cases of CF can be treated with anti-inflammatory drugs and other medications, patients with advanced lung disease as a result of the condition may need to undergo lung transplantation.
For their study, researchers from Johns Hopkins Medicine in Baltimore, MD, and the UK’s government-funded National Health Service (NHS) set out to see whether the survival of patients who receive lung transplantation for CF varies by the type of insurance they are covered by.
“Lung transplantation is among the most complex procedures performed today, one that requires a wealth of resources and careful long-term management by multiple specialists, and as such remains an imperfect therapy,” notes senior investigator Dr. Ashish Shah, associate professor of surgery and surgical director for heart and lung transplantation at Johns Hopkins. “So it is paramount that we pinpoint and eliminate any systemic factors that interfere with its success.”
The study included 2,307 patients with CF aged 12 years or older from the UK and US who underwent lung transplantation or combined heart-lung transplantation between 2000 and 2011.
All of the UK patients were publicly insured through the NHS, 39% of US patients were publicly insured with Medicare or Medicaid, while the remaining US patients had private insurance.
The researchers found that patient outcomes in the 1-3 months following surgery did not differ by insurance types, but this was not the case when assessing long-term outcomes.
The team found that publicly insured UK patients had an average survival of 8.1 years, while publicly insured Americans survived for an average of 4.7 years. Privately insured Americans also had slightly poorer outcomes than UK patients, with an average survival of 7.9 years.
These results remained even after the researchers considered factors that may influence survival, such as patients’ age, the condition of their lungs prior to surgery and their overall health.
Dr. Shah says these findings highlight a significant gap in public health insurance between the US and UK. He adds:
“Our results indicate that the United Kingdom’s national public health insurance system outperforms its US equivalent, and given that a significant portion of Americans rely on publicly funded insurance for their medical coverage, we, as a country, ought to have an honest conversation about the reasons behind this disparity and find ways to close the gap.”
Lead study author Dr. Christian Merlo, a pulmonary and critical care specialist and assistant professor or medicine at the Johns Hopkins University School of Medicine, says that the idea of introducing a single-payer health system like the NHS in the US has been largely criticized.
One main criticism, he notes, is the fear that there would be a lack of resources relative to demand, which would lead to poorer care.
“The comparable outcomes between lung transplant patients with public health insurance in the UK and their privately insured US counterparts indicate this fear may be unfounded or largely exaggerated,” says Dr. Merlo.
In September 2014, a study published in JAMA Pediatrics revealed that, while the Patient Protection and Affordable Care Act (PPACA) has led to increased health insurance coverage among young adults, it has not improved health care affordability or health status among this population.