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MEDICAID AND UNINSURED PATIENTS HAVE FEWER CARDIAC PROCEDURES.

Does insurance status affect patient care? Analysis of 1985 data from Massachusetts patients hospitalized for chest pain or circulatory disorders indicates that it may.

Using multivariate analysis to control for demographic factors, hospital type, and diagnosis (based on the limited clinical data available on discharge abstracts), investigators found that privately insured patients had much higher rates of cardiac procedures than uninsured patients: they were 80 percent more likely to undergo coronary angiography, 40 percent more likely to undergo coronary- artery bypass grafting, and 30 percent more likely to undergo coronary angioplasty. Rates of angiography and bypass surgery were similar for Medicaid and uninsured patients, although Medicaid patients were only half as likely as uninsured patients to undergo angioplasty.

These data show that payer status is strongly associated with the use of cardiac procedures, although the lack of detailed clinical data leaves open the possibility that clinical factors explain the variability in rates. These findings raise concern about whether Medicaid and uninsured patients are receiving an acceptable quality of care for their cardiovascular problems, or whether cardiac procedures are overutilized in privately-insured patients.

— THL

Published in Journal Watch General Medicine September 21, 1990

Citation(s):

Wenneker MB et al. The association of payer with utilization of cardiac procedures in Massachusetts. JAMA 1990 Sep 12 264 1255-1260.

• Medline abstract (Free)