A study by Harvard University researchers says 102 deaths in Hawai'i in 2005 were associated with a lack of health insurance.

The study published in the online edition of the American Journal of Public Health found a bigger correlation between an absence of health coverage and death than previously thought, determining about 45,000 deaths annually in the U.S. are linked to a lack of coverage.

That was about 2 1/2 times higher than the Institute of Medicine estimated in 2002, the study said.

The research is among the studies and reports being issued as the country debates health care reform, including ways insurance can be extended to everyone. Earlier this week, Families USA released a report saying health insurance premiums in Hawai'i had risen an estimated 3.7 times faster than worker earnings during the past 10 years.

The Business Roundtable also issued a report saying annual health care costs per employee would triple to $29,000 nationally over the next decade.

The Harvard study looked at uninsured people between ages 17 and 64 and determined they have a 40 percent higher risk of death than people who are insured.

The report noted the insured are more apt to get care when needed, have a regular doctor and have continuity of coverage.

Dr. Leslie Hartley Gise, a Maui psychiatrist, said there are a number of studies that have noted the uninsured don't get preventive treatments and hesitate going to the doctor when they're sick because they are afraid of getting a big bill.

"They don't have a doctor who knows them — if they're the type of person who makes a big deal out of everything or the type of person who says it's fine when it's not.

"When they are really sick, they go to the emergency room where no one knows them. And the doctor does the best he or she can with a crowded, over-utilized facility that's not meant for regular care."

Gise is a member of Physicians for a National Health Program, a group that advocates the creation of a single-payer national health insurance program. Two of the study co-authors, Dr. Steffie Woolhandler and Dr. David Himmelstein, are co-founders of the 17,000-doctor group. The lead author of the work was Dr. Andrew Wilmer, who was at Harvard Medical School when the study was done.

A single-payer plan is not among the ideas being considered on Capitol Hill as health care reform is debated.

Critics of single-payer systems don't like the idea of the federal government exerting control over health care coverage. They say it is too socialistic and has resulted in long waits for some medical procedures in other countries.

Gise said the single-payer idea merits consideration because it is a lower cost solution compared to what's being considered for health reform. She said currently too much of doctors' time is spent finding out what treatments private insurance companies will approve for their patients along with filling out forms that vary from insurer to insurer.

"Single-payer is the most fiscally conservative reform and it's the only one that does not cost more than what we're paying now," Gise said.

The research being published concludes the health reform debate gives physicians an opportunity to advocate for universal coverage, but that the idea is politically troublesome.

"The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance," it said.

"Despite widespread acknowledgement that enacting universal coverage would be life saving, doing so remains politically thorny."

The study was produced using data from National Center for Health Statistics and was adjusted for a variety of factors, including race, income, education, smoking, exercise and body mass index.

It noted limitations of the study included being able to validate self-reported insurance status and being able to measure the effect of gaining or losing coverage after survey interviews.

Last year about 7.8 percent of Hawai'i residents, or 98,000 people, were uninsured, according to U.S. Census Bureau data.