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Health maintenance organizations and hospital quality for coronary artery bypass surgery
J J Escarce1, R L Van Horn, M V Pauly
1RAND Health Program, Santa Monica, CA 90407-2138, USA. jose_escarce@rand.org
Insights
Health Maintenance Organization (HMO) coverage impacts hospital quality for coronary artery bypass graft (CABG) surgery differently in California and Florida, affecting patient outcomes based on insurance type and location.
Area of Science:
- Health Services Research
- Cardiovascular Surgery Outcomes
- Managed Care Policy
Background:
- Managed care organizations, such as Health Maintenance Organizations (HMOs), are prevalent in healthcare delivery.
- Assessing the quality of care provided to patients undergoing major surgical procedures like coronary artery bypass graft (CABG) surgery is crucial.
- Geographic variations and patient population characteristics may influence the relationship between insurance type and healthcare quality.
Purpose of the Study:
- To compare the quality of hospitals used by Health Maintenance Organization (HMO) and non-HMO patients for coronary artery bypass graft (CABG) surgery.
- To investigate potential differences in hospital quality based on insurance type (HMO vs. non-HMO) in California and Florida.
- To explore how patient populations and managed care market structures might affect the association between HMO coverage and hospital quality.
Main Methods:
- Utilized hospital discharge data from 1992-1994 for patients undergoing coronary artery bypass graft (CABG) surgery.
- Compared hospital quality metrics between commercially insured HMO and non-HMO patients, controlling for patient distance to the hospital.
- Analyzed differences in hospital quality for Medicare HMO patients versus standard Medicare program patients in Florida.
Main Results:
- Commercially insured HMO patients in California utilized higher quality hospitals for CABG surgery compared to commercially insured non-HMO patients.
- In Florida, commercially insured HMO and non-HMO patients were distributed similarly across hospitals of varying quality.
- Medicare HMO patients in Florida were found to use lower quality hospitals than patients in the standard Medicare program.
Conclusions:
- The relationship between Health Maintenance Organization (HMO) coverage and hospital quality for CABG surgery is not uniform across all regions and patient groups.
- Market maturity and organizational structure of managed care likely play a significant role in these observed differences.
- Further research is warranted to understand the nuances of managed care's impact on surgical quality in diverse healthcare markets.
Abstract:
This study uses hospital discharge data for 1992-1994 to assess differences between HMO and insured non-HMO patients in California and Florida with regard to the quality of the hospitals used for coronary artery bypass graft (CABG) surgery. The authors found that commercially insured HMO patients in California used higher quality hospitals than commercially insured non-HMO patients, controlling for patient distance to the hospital. In contrast, commercially insured HMO and non-HMO patients in Florida were similarly distributed across hospitals of different quality levels, whereas Medicare HMO patients in Florida used lower quality hospitals than patients in the standard Medicare program. The authors conclude that the association between HMO coverage and hospital quality may differ across geographic areas and patient populations, possibly related to the maturity and structure of managed care markets.