
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: THURSDAY, May 25, 1995                   TAG: 9505250104
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO 
SOURCE: Seattle Times
DATELINE: SEATTLE                                LENGTH: Medium

LACK OF INSURANCE DETERMINES CARE

Doctors are nearly twice as likely to withdraw life supports from dying patients if the patients don't have a private physician or private health insurance, a new study suggests.

Researchers at Barnes Hospital at the Washington University School of Medicine in St. Louis found the trend in a study of 159 intensive-care-unit patients over one year.

Marin Kollef, the study author and the hospital's critical-care director, said that although the study was relatively small, it raises important questions for future research.

``Do we provide different levels of care based on socioeconomic status? Does that result in different [medical] outcomes?'' he asked.

Kollef discussed the study at the American Lung Association-American Thoracic Society International Conference in Seattle. Nearly 13,000 physicians and researchers attended the meeting at the Washington State Convention and Trade Center.

Most medical ethicists agree life supports may be withdrawn if a patient has written or told someone that the measures should stop when there is no chance of recovery. If there has been no explicit statement, the decision is made by family members, friends and physicians, based on what they think the patient would have wanted.

Even with such guidelines, Kollef said the issue of when to withdraw life supports from terminally ill patients is very complicated.

Kollef's study examined the medical records of 159 terminally ill patients. Life supports were withdrawn from 69 of those patients and were maintained with 90 patients.

Life supports were withdrawn from 58 percent of those without a private physician or private health insurance. They were withdrawn from 33 percent of those patients with private doctors and insurance.

The study also found that those patients with private physicians and insurance incurred about twice the medical costs as the other group.

``We need to have much larger databases to really understand what's going on,'' Kollef said.

Kollef said he hopes to conduct future studies with many more patients, categorizing them according to socioeconomic status, insurance and other factors.

by CNB