The association of payer with utilization of cardiac procedures in Massachusetts

Article Abstract:

The effects of who pays for treatment (payer) on the provision of standard forms of cardiovascular surgical treatment for patients with coronary heart disease is evaluated. (Coronary heart disease involves the circulation of the heart itself.) The medical history abstracts of 37,994 individuals with circulatory diseases, who were discharged from Massachusetts hospitals during fiscal year 1985, were statistically analyzed, and classified by payer status: uninsured, private insurance, and Medicaid. The numbers of patients who received coronary angiography (a specialized X-ray designed to visualize blood flow through the vessels of the heart), bypass grafting (replacing diseased coronary vessels), and angioplasty (repairing damaged coronary vessels) were collected and correlated to payer status. Although patients should receive treatment based on their physical condition, not as a result of their economic condition, the findings demonstrate a bias in treatment correlated with who pays the hospital and physician bills. The odds that a privately insured patient would receive a highly useful angiogram were 80 percent greater than for an uninsured patient. Similarly, the privately insured had a 40 percent greater chance of receiving a bypass, and 28 percent increased likelihood of undergoing angioplasty. Medicare patients fared a similarly reduced rate for angiography and bypass surgery, but were 48 percent less likely to be treated with angioplasty than the uninsured group. This is the first known study to demonstrate that the nature and source of reimbursement affected the forms of treatment offered to cardiac patients. These data call into question how financial issues influence the medical decision-making process. One should not assume, however, that the uninsured or those on Medicare experienced poorer outcomes as a result of this bias. Various studies have shown that a large number of bypass operations and angioplasties are not performed for appropriate causes. This study does, however, raise serious issues about the provision of quality medical care for individuals of reduced socioeconomic status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical economics, Statistics, Health insurance, Angiography, Coronary artery bypass, Medicare, Medical fees, Angioplasty

Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts

Article Abstract:

Interracial differences in the use of three coronary procedures, namely angiography, coronary artery bypass grafting and angioplasty were studied for both white and black patients.. Coronary angiography involves X-raying the coronary arteries which supply the heart muscle; in coronary artery bypass grafting, blood vessels are grafted around a blocked coronary artery; in coronary angioplasty, blockages of a coronary artery are cleared. These procedures can have substantial health-care benefits when used appropriately. After a number of variables such as age, gender and diagnosis were taken into account, it was found that whites on the whole underwent significantly more angiography and coronary artery bypass grafting surgery. Although utilization differences may reflect patient preferences or different levels of disease severity or socioeconomic status not adequately taken into account, the study still suggests that racial inequalities exist in the use of these procedures.

Case studies, Evaluation, African Americans, Coronary heart disease, Massachusetts, Discrimination in medical care, Medical care discrimination

Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland

Article Abstract:

Uninsured patients or those who are covered by Medicaid may be more likely to be hospitalized for conditions that can be treated on an out-patient basis or that can be avoided entirely than insured patients. A study examined the number of hospitalizations for 12 different avoidable hospital conditions (AHCs) among patients discharged from hospitals in Massachusetts and Maryland during 1987. Uninsured patients were more likely to be hospitalized for 10 AHCs in Massachusetts and for seven AHCs in Maryland than privately insured patients. Patients who were covered by Medicaid were more likely to be hospitalized for nine AHCs in Massachusetts and seven AHCs in Maryland than patients with private insurance. The AHCs included a ruptured appendix, asthma, cellulitis, congestive heart failure, diabetes, gangrene, severe hypertension and pneumonia.

Care and treatment, Medically uninsured persons, Hospitalization, Medicaid, Hospital care