By Elizabeth Cooney, Globe Correspondent

Uninsured people are also more likely to have undiagnosed and undertreated medical conditions, according to a new study comparing chronic illnesses among Americans with and without health coverage. The results offer possible clues to a recently reported higher death rate among people who lack insurance.

Researchers from Cambridge Health Alliance and Boston Medical Center tracked diabetes, high blood pressure, and high cholesterol in a national survey of more than 15,000 working-age adults. Based on questionnaires, medical exams, and lab test results, they found that about half of uninsured people who had diabetes or high cholesterol were unaware of it, compared with just under one-quarter of insured people who did not know they had these conditions. High blood pressure, however, was undiagnosed in about a quarter of both uninsured and insured people.

Once diagnosed, hypertension was poorly controlled in 58 percent of uninsured people and 51 percent of those with insurance. The treatment gap was larger for high cholesterol: 77 percent of uninsured versus 60 percent of insured people had inadequately treated levels.

For diabetes control, the difference in treatment was not as clear. Insurance status did not matter in achieving good diabetes control, as defined by the national survey conducted by the US Centers for Disease Control and Prevention. But using less stringent measures that the authors say are more commonly used by physicians, 31 percent of uninsured diabetics were in poor control of their blood sugar levels, compared with 25 percent of insured diabetics.

"The diagnosis and control of chronic illness is substandard even in people with insurance," Dr. Steffie Woolhandler, co-author of the article appearing online today in Health Affairs, said in an interview. "But it's much, much worse for the uninsured."

As medical care has improved for people with health insurance, the consequences of being uninsured have worsened, according to a new study that says the lack of coverage translates into nearly 45,000 deaths each year among working-age Americans.

Researchers from Cambridge Health Alliance report in the American Journal of Public Health on a study that followed 9,005 adults under 65 years old who took part in a national survey conducted by the Centers for Disease Control and Prevention from 1986 through 1994. After 12 years, 351 people had died. Sixty of them were uninsured and 291 were insured.

After accounting for age, education, income, and other factors, the researchers found that people without private insurance had a 40 percent higher risk of dying than people with private insurance. An earlier study by the Institute of Medicine based on 16 years of data through 1993 found that uninsured people had a 25 percent higher risk of dying than insured people, which translated into 18,000 additional deaths.

"Being uninsured is more lethal relative to being insured than it was 20 years ago," co-author Dr. Steffie Woolhandler said in an interview.

Patient satisfaction and aggressive care don't necessarily go hand in hand, according to new hospital ratings prepared by Consumer Reports.

Drawing on government surveys compiled on the Hospital Compare web site and the Dartmouth Atlas of Health Care intensity index, the consumer ratings publisher has ranked the nation's more than 3,000 hospitals on its online health site, using the same red and black blobs familiar from ratings of cars or digital cameras.

Patient satisfaction covered eight categories, from cleanliness to communication, and intensity was measured by the number of tests conducted, doctors' visits made, procedures performed, and days spent in the hospital. Consumer Reports reverses how Dartmouth reports intensity, instead presenting aggressive care at the low end and conservative care at the high end of a spectrum from 1 to 100.

The top 28 teaching hospitals -- those that ranked significantly above the national average in patient satisfaction -- on average practiced more conservative medicine than 59 percent of hospitals, according to Dartmouth benchmarks for chronic care.

Brigham and Women's Hospital and Massachusetts General Hospital, the only two hospitals in the state to make the highest performers' list, were among the exceptions. The Brigham's Dartmouth score says it is more conservative than 29 percent of hospitals and Mass. General is more conservative than 18 percent on a spectrum where aggressive scores are low and conservative scores are high.

That stands in contrast to the Dartmouth-affiliated Mary Hitchcock Memorial Hospital in Lebanon, NH. Its overall patient satisfaction score of 81 is one point ahead of the Brigham and one point below Mass. General, but its Dartmouth score says its care is more conservative than 88 percent of hospitals.

"Mass. General does very well and so does the Brigham among better-performing hospitals. They are more toward the aggressive end of the spectrum, but what we try to communicate to folks is a more conservative approach doesn't lessen patient satisfaction," Dr. John Santa, director of the Consumer Reports Health Ratings Center, said in an interview. "It actually appears to be associated with a better experience."

More than 500 medical students, doctors, and professors have signed a petition urging Harvard Medical School to restore funding for its Division of Primary Care, cuts the school says reflects a reorganization and not a retrenchment from its commitment to primary care medicine and education.

"Such a budget cut seems at odds with both increased national recognition of the crisis in primary care and encouraging signs of late that Harvard acknowledges its responsibility to help address this crisis," the petition says.

Spiraling healthcare costs contributed to more than three of every five bankruptcies, according to a national survey conducted before the current economic downturn, even though most of the people had health insurance before they became ill.

Researchers from Cambridge Health Alliance and Harvard Law School analyzed a random national sample of more than 2,000 bankruptcy records in 2007, sent questionnaires to those debtors, and followed up with telephone interviews of about 1,000 of them. Unpaid medical bills or, to a lesser extent, illnesses that resulted in lost jobs contributed to 62.1 percent of bankruptcies, even though most had insurance.

A prominent critic of drug industry influence on healthcare is calling for the medical profession to eliminate free drug samples, asserting that they can harm patients and raise costs while serving only as a marketing tool.

Dr. Jerome P. Kassirer, a professor at Tufts University School of Medicine and a former editor of the New England Journal of Medicine, builds a case for banning drug samples in an essay he wrote with Susan Chimonas of the Center on Medicine as a Profession at Columbia University.

"The tradition of physicians dispensing samples has many serious disadvantages and is as anachronistic as bloodletting and high colonic irrigations," the authors write in this week's PLoS Medicine. "As the profession begins to slowly extract itself from the influential grip of industry, it must also deal with the undue influence of free samples."

By Elizabeth Cooney, Globe Correspondent

CAMBRIDGE -- Massachusetts will use $764 million from the federal stimulus package to shore up healthcare services and prevent further job and program cuts at hospitals that serve large numbers of poor patients, Governor Patrick said today.

The money, which is coming to the state through the Medicaid program, will also enable the state to preserve current benefits and eligibility levels for MassHealth recipients, and for residents who get subsidized health insurance under the 2006 law mandating insurance coverage. A reserve fund will be set up to meet anticipated increases in demand for the programs driven by the economic downturn.

Other programs for people with mental illness and disabilities will also see an infusion of funds, as will public health, youth services, and agencies serving children and families, the administration announced.

"We've had to make cuts, that's true. But thanks to the recovery funds, we have softened some of the blow," Patrick told an overflow crowd yesterday afternoon at Cambridge Hospital. "We can't avoid every tough decision in health and human services .... But we are doing everything we can to minimize the impact on the populations that depend on you and your government more in times like these."

Boston researchers are sounding the alarm about the fitness of firefighter and ambulance crew recruits in Massachusetts.

New research shows that 77 percent of candidates for firefighting and emergency medical technician positions were overweight or obese. The study, published online today in the journal Obesity, was conducted by researchers from Boston University School of Medicine, Harvard University and the Cambridge Health Alliance.

"If they are beginning their careers overweight and obese unless there is an intervention, it would be worse over time," said Dr. Stefanos Kales, director of the occupational & environmental medicine residency at the Harvard School of Public Health and senior author of the study.

By Liz Kowalczyk, Globe Staff

Cambridge Health Alliance, which is facing significant financial problems, said today it will reduce its workforce by more than 300 employees, end inpatient hospital care in Somerville, and close six outpatient clinics and shut down its overnight pediatric beds and addiction unit.

Somerville Hospital will continue to operate a 24-hour emergency room, and the health care network's two other hospitals, in Cambridge and Everett, will remain open. Hospital officials said the reorganization plan is more dramatic than initially thought because the already-struggling hospital system was then hit with the recession.

"The original plan was for a more gentle rollout of the changes," said spokesman Doug Bailey. "But the economy that has affected everyone derailed us a little bit."

Worries about the intrusion of electronic medical records into the doctor-patient relationship are mounting with their wider adoption.

Dr. Pamela Hartzband and Dr. Jerome Groopman of Beth Israel Deaconess Medical Center, while appreciating the accessibility and efficiency EMRs can bring, wrote earlier this year about potential damage to the doctor's office visit in the New England Journal of Medicine. In a column appearing in the Globe last year, Dr. Michael Hochman of Cambridge Health Alliance said computers can make encounters more mechanical.

In tomorrow's Journal, Dr. Abraham C. Verghese of Stanford University considers medical students and residents marooned in the cool glow of computer-filled bunkers, gazing at patient records instead of visiting patients in the hospital beds they warm.

It wasn't hard to lure the doctors in training out to the wards, Verghese writes, where they watched him use his diagnostic skills to read what was happening with the patients.

"The body is the text, a text that is changing and must be frequently inspected, palpated, percussed, and auscultated," he writes. "The scent in the room, a family member's statement contradicting what the patient says, the knobby liver, clonus, the absent nasolabial fold, the hoarse voice — a multitude of such soundings help us understand the patient, and on this foundation, data from the chart can be selectively applied."

That stands in contrast to the "iPatient," he says, a compilation of lab results, imaging scans, and "chartomas," or disease labels cut and pasted into the record so many times they accumulate more weight than their due.

Hartzband, of Beth Israel Deaconess and Harvard Medical School, agrees with Verghese.

"I think that the technology that has become omnipresent in medicine is tremendously valuable," she said in an interview today. But "it does tend to draw you away from the patient."

Young doctors aren't rewarded by taking their own patient histories, she said, because they are pressed for time and expect what's in the electronic medical record to be sufficient.

That's pedagogically tragic, Verghese says, and not good for the patient. Education is where the change can take place: Master clinicians known for their clinical skills can be drafted to teach what they know, said Verghese, who is senior associate chair for the theory and practice of medicine at Stanford.

Hartzband said it's a struggle to figure out how to take advantage of electronic medical records and computer-based information while preserving what's good about the traditional hands-on medicine.

"The best medicine is not very efficient. It takes time," she said. "And that's what we don't have."