Assistant Professor Joseph Doyle

April 2003, MIT Sloan faculty/staff page

Automobile accident victims who lack health insurance receive 20 percent less treatment in hospitals and are 37 percent more likely to die of their injuries than victims with health coverage, according to new research by MIT Sloan Assistant Professor Joseph J. Doyle Jr.

“Insurance status has a significant effect on treatment decisions and ultimately patient outcomes,” concluded the study by Doyle, who based his findings on a unique data set that links police accident reports with hospital records.

“A lot of studies show that the uninsured get less care, but that may be because they are less likely to go to doctors in the first place or because of other factors,” says Doyle. “For my study, I picked a case — car accidents — where people have no choice about seeking medical care. Beyond the amount of care received, we also looked at health outcomes and found higher mortality for the uninsured. Emergency rooms are not as much of a safety net as people think. The uninsured still get a lot of care, but are less likely to receive the expensive critical treatments that can save lives.”

Insurance status matters

Using data collected in Wisconsin, Doyle controlled for age, accident severity and other factors, including seat belt use.

“Comparisons to patients who do not have automobile insurance [but do have health insurance] and those receiving Medicaid suggest that health insurance status is driving the results, not underlying differences in income, attitudes toward risk, or health status,” according to the study.

While doctors and other providers generally insist that insurance status has no bearing on the quality or quantity of care delivered, Doyle's study indicates otherwise.

“In fact, it appears that one of the first pieces of information discovered (about people coming into emergency rooms) is insurance status,” it says.

Catastrophic coverage a real safety net

Doyle, a labor economist who studies health and child welfare issues, says his research has major implications for health care policy.

“Because car crashes are the leading cause of death for people under 35, these issues are exactly the kind of thing we should be thinking about.”

With a recent government report that health care costs rose by nearly nine percent from 2000 to 2001, Doyle's research is also significant to health care providers.

If automobile accident victims at least carried catastrophic coverage — which costs about $300 a year in Wisconsin, according to Doyle — emergency rooms would receive at least some reimbursement for treating car accident victims and might thus be more likely to provide more of the advanced care given to people with full insurance coverage.

“If people knew that the emergency room safety net is really not there as much as they think it is, they might go for at least catastrophic insurance,” says Doyle.

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MIT Sloan Professor Emeritus Jay Forrester invented the field of system dynamics and is still a major force in its development.