U.S. IPF Lung Transplant Patients With Public Insurance Have Worse Outcomes than UK Patients


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Lung transplantation is one option for patients with pulmonary fibrosis, however, according to a recent study, Americans with public insurance that undergo lung transplantation for conditions such as pulmonary fibrosis have worse long-term outcomes than equivalent United Kingdom patients with public insurance and Americans with private insurance.

The study published in the American Journal of Transplantation, was conducted by Johns Hopkins in Baltimore researchers and U.K. colleagues who are working in UK’s government-funded National Health Service. 

“Our results indicate that the United Kingdom’s national public health insurance system outperforms its U.S. 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,” said senior investigator Ashish Shah, M.D., associate professor of surgery and surgical director for heart and lung transplantation at Johns Hopkins in a recent news release.

“The U.K. National Health Services’ lung transplant program equals the top-notch care achieved under American private insurance and outperforms care received by publicly insured Americans,” said Stephen Clark, D.M., professor of cardiothoracic surgery at the University of Northumbria and Freeman Hospital in Newcastle and lead investigator of the U.K. team. “The results of the study underscore the ability of publicly funded health care systems to achieve excellent results in complex transplant surgery, and this is something we are rather proud of.”

The investigators point out that they did not account for particular causes of the difference in survival rates, however, their results deserve attention in order to understand the factors accounting for these differences.

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“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,” Shah said in the news release. “So it is paramount that we pinpoint and eliminate any systemic factors that interfere with its success.”

In the study, the researchers compared 12 years worth of records with information about survival and death in approximately 2,700 cystic fibrosis patients, aged above 12 years who had either lung or combined heart-lung transplantation from 2000 to 2011 in the United States or the United Kingdom.

The results revealed that of the 2,307 American patients, 39% had Medicare or Medicaid public insurance. All of the U.K. patients had National Health Service public insurance. The researchers found that the postoperative outcomes were similar for both UK and US patients, however there were relevant differences over the long run.

Among the UK patients, the average survival rate was of 8.1 years, compared to 7.9 years among Americans with private insurances and of 4.7 years among Americans with public insurance, and these differences were present even when controlling for overall health, age, and lung condition before transplantation.

According to the researchers the study results indicate that the national health care system can offer appropriate care, and be able to achieve long-term outcomes similar to those observed in private health insurance.

“One of the popular criticisms of a single-payer health system has been the fear of scarcity of resources and rationing that may lead to suboptimal care,” said study lead author Christian Merlo, M.D., M.P.H., a pulmonary and critical care specialist and assistant professor of medicine at the Johns Hopkins University School of Medicine. “The comparable outcomes between lung transplant patients with public health insurance in the U.K. and their privately insured U.S. counterparts indicate this fear may be unfounded or largely exaggerated.”