Relationship Between Insurance Status and Receipt of Cardiac Tests and Procedures During Hospitalization: A...

Area of Science:

• Cardiology
• Health Services Research
• Health Economics

Background:

• Previous research on insurance status and healthcare utilization shows conflicting results, often focusing on outpatient settings.
• Understanding disparities in diagnostic and procedural intensity for hospitalized patients is crucial.

Purpose of the Study:

• To compare the rates of cardiac diagnostic tests and procedures between hospitalized Medicaid and commercially insured patients.
• To characterize the relationship between primary payer status and procedural intensity in inpatient cardiac care.

Main Methods:

• A propensity score-matched sample of adult patients from four US states (2016-2018) was analyzed.
• Key outcomes included receipt of echocardiogram, stress test, cardiac catheterization, and pacemaker/cardiac rhythm monitor implantation.
• Adjusted odds ratios were calculated using generalized linear models, controlling for demographic and socioeconomic factors.

Main Results:

• Commercially insured patients demonstrated higher likelihoods of receiving all analyzed cardiac tests and procedures compared to Medicaid patients.
• Adjusted odds ratios ranged from 1.16 for cardiac catheterization in ST-segment-elevation myocardial infarction to 1.40 for pacemaker implantation.
• Significant differences were observed across various cardiac interventions.

Conclusions:

• Hospitalized commercially insured individuals underwent a broader spectrum of cardiac procedures than their Medicaid counterparts.
• Potential drivers include physician/patient preferences, financial incentives, and social determinants of health.
• Findings underscore the necessity for value-based hospital payment models to mitigate healthcare inequities.