Newswise — A new analysis suggests that universal health insurance might not save many adult lives — or any — if the United States actually puts it into place.

A previous estimate by the influential Institute of Medicine is too optimistic, said Richard Kronick, a former health care adviser to President Clinton who crunches numbers in a study appearing online in the journal Health Services Research.

In contrast to the Institute's estimate that universal coverage would save 18,000 adult lives per year, Kronick thinks the number is substantially smaller and possibly around zero.

"It's quite counterintuitive and it's not a message that most people, including myself, want to hear," said Kronick, a professor of family and preventive medicine at the University of California at San Diego. However, "the evidence we have concerning the relationship between lack of insurance and mortality is not very good, and a reasonable reading of that evidence is that the number of deaths in the United States probably wouldn't change a lot if everybody gets health insurance."

In 2002, the Institute of Medicine, which advises politicians and the public, estimated that uninsured people are 25 percent more likely to die than the insured. The Institute estimated that 18,000 adults in the United States would survive each year instead of dying if they had insurance. An updated 2006 estimate using the same approach boosted the number to 22,000.

In his analysis, Kronick examined a national study that tracked 643,001 people who responded to health surveys from 1986 to 2000, with researchers following them through 2002.

After adjusting figures to account for factors such as income and "health status," Kronick found that having insurance made little or no difference to the overall mortality rate for people ages 18 to 64.

He estimates that no more than 9,000 people die each year who would otherwise survive if they had health insurance.

Willard Manning, who worked on the 2002 Institute of Medicine report, said different studies can result in different conclusions because there are so many ways to look at the numbers.

Kronick's study and the 2002 report, for example, take different approaches to accounting for high-risk patients who get insurance because they're sick, said Manning, a professor of health studies at the University of Chicago. Overall, however, Manning still believes that more insurance will lead to fewer deaths.

"To me, that's going to have some consequence for mortality," he said, because the sick who can't afford care will cut back on seeing doctors.

Christine Stencel, spokesperson for the Institute of Medicine, said the authors of the 2002 report carefully considered research when they made their estimate.

There is one "inarguable conclusion," she said. "Lack of coverage is a health hazard. Lack of insurance raises people's risk of illness, complications and, yes, premature death"¦The point is that it is no longer possible, in the face of all the evidence, to say that lack of health insurance does not negatively impact Americans' health, lives, and well-being. It clearly does."

Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or [email protected]. HSR is available online at

Kronick R. Health insurance coverage and mortality revisited. Health Services Research online, 2009.

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Health Services Research