Insurance Type, Citizenship Influences Lung Transplantation Outcomes

For patients who undergo a lung transplant (LTx) to treat cystic fibrosis (CF), UK citizens and US private insurance holders had better health outcomes than Americans under public insurances, according to John Hopkins and UK researchers.

For their study, investigators assessed the US’s United Network for Organ Sharing (UNOS) registry and the UK’s National Health Service (NHS) Transplant Registry for the outcomes of CF patients who underwent a lung or heart—lung transplantation between Jan. 1, 2000 and Dec. 31, 2011.

From their analysis, the team yielded 2,307 and 451 LTx recipients from the US and UK, respectively. Furthermore, they found US private insurance holders and UK patients had better survival outcomes, with 894 (38.8%) of patients who died being under Medicare or Medicaid insurance.

Reporting their findings in the American Journal of Transplantation, the researchers noted, “In multivariable Cox regression, US Medicare/Medicaid insurance was associated with worse survival after LTx (US private: HR0.78,0.68—0.90,p = 0.001 and UK: HR0.63,0.41–0.97, p = 0.03).”

The authors concluded, “Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.”

Their findings indicated that the UK National Health Services’ LTx publically available program rivaled American private insurance. Moreover, the study’s lead UK investigator, Stephen Clark, DM professor of cardiothoracic surgery at the University of Northumbria and Freeman Hospital in Newcastle claimed their study also shows the potential of US’ public insurances to successfully conduct a complex surgical procedure.

The study’s senior investigator, Ashish Shah, MD, associate professor of surgery and surgical director for heart and lung transplantation at Johns Hopkins said, “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.”