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Expected source of payment and use of hospital services for coronary atherosclerosis
D H Kuykendall1, M L Johnson, J M Geraci
1Health Services Research and Development Field Program, Department of Veterans Affairs, Houston, Texas, USA.
Insights
Patients with private insurance received more revascularization procedures for coronary atherosclerosis than Medicaid or uninsured patients. Medicaid patients experienced longer hospital stays without procedures, suggesting payer influences healthcare access.
Area of Science:
- Health Services Research
- Cardiovascular Medicine
- Health Economics
Background:
- Access to cardiovascular services can vary significantly among patient populations.
- Understanding the influence of insurance payer on the provision of medical services is crucial for healthcare equity.
- Coronary atherosclerosis management involves complex procedures and varying lengths of hospital stay.
Purpose of the Study:
- To investigate the relationship between patient insurance payer and the services received for coronary atherosclerosis.
- To determine if insurance status affects the likelihood of undergoing revascularization procedures or experiencing prolonged hospital stays.
Main Methods:
- Analysis of 24,424 hospital discharge abstracts from California acute care hospitals in 1989.
- Examined services included coronary artery bypass surgery, percutaneous transluminal coronary angioplasty (PTCA), and length of stay (LOS).
- Regression analyses controlled for demographic factors and comorbidities.
Main Results:
- Privately insured patients were significantly more likely to receive revascularization (bypass or PTCA) compared to Medicaid or uninsured patients.
- Medicare and Health Maintenance Organization (HMO) patients had similar revascularization rates to privately insured patients.
- Medicaid patients had the highest likelihood of long length of stay (LOS) without revascularization.
Conclusions:
- Strong associations exist between patient payer status and the provision of cardiovascular services, potentially driven by financial incentives.
- Variations in procedure performance thresholds or admission practices may explain observed disparities.
- Further research is needed to elucidate the specific mechanisms behind these payer-driven differences in care.
Abstract:
To study associations between payer and provision of services for patients hospitalized for coronary atherosclerosis, the authors analyzed abstracts of 24,424 discharges from California acute care hospitals during 1989. Services examined included receipt of coronary artery bypass surgery, percutaneous transluminal coronary angioplasty (PTCA), long length of stay (LOS) without revascularization, and overall LOS. Regression techniques controlled demographic factors and comorbidities. The privately insured were 96% more likely to undergo revascularization (either bypass or PTCA) than Medicaid discharges and 117% more likely than the uninsured. Odds of revascularization for Medicare and health maintenance organization discharges resembled those for the privately insured. Analyzed separately, PTCA was far more likely among the privately insured than Medicaid beneficiaries and the uninsured. In addition, the adjusted odds for PTCA were 52% greater for the privately insured than for health maintenance organization discharges. The greatest likelihood of long LOS without revascularization and the greatest overall LOS was observed for Medicaid discharges. Strong associations, consistent with financial incentives to provide care, exist between payer and provision of services. Future studies need to address whether variations in process result from differences in thresholds for procedure performance, differences in admission practices, or both.