 |
|
Health Insurance Coverage and Outcome Following Acute Myocardial InfarctionA Community-wide Perspective
Silvia Kreindel, DVM, MPH;
Ronald Rosetti, MPH;
Robert Goldberg, PhD;
Judith Savageau, MPH;
Jorge Yarzebski, MD, MPH;
Joel Gore, MD;
Arthur Russo, MD;
Carol Bigelow, PhD
Arch Intern Med. 1997;157(7):758-762.
Abstract
| |
Background
Several studies have suggested that type of medical insurance coverage is associated with hospital utilization rates and receipt of selected diagnostic or treatment approaches. To our knowledge no studies, however, have examined the relation between medical insurance coverage and short-term outcomes following acute myocardial infarction (AMI) from a multihospital, community-wide perspective.
Objective
To examine the association between medical insurance coverage and in-hospital case-fatality rates as well as length of hospital stay following AMI.
Methods
The study sample consisted of 3735 residents of the Worcester, Mass, metropolitan area hospitalized with validated AMI during 1986, 1988, 1990, 1991, and 1993 at all metropolitan Worcester hospitals. Data were obtained from the review of medical records. Patients were stratified into 5 medical insurance groups for purposes of analysis: private or commercial (n=711), Medicaid (n= 101), Medicare (n=1991), health maintenance organization (n=741), and self-pay or other (n=191). Crude and multivariable -adjusted analyses were used to examine the relation between medical insurance coverage and length of hospital stay and in-hospital case-fatality rates following AMI.
Results
In-hospital case-fatality rates during the period under study were 7.7%, 11.9%, 21.4%, 9.3%, and 10.0% in the 5 medical insurance groups, respectively. After adjusting for several factors that may affect in-hospital mortality, relative to the referent group of private or commercial insurance patients (odds ratio, 1.0), the multivariable-adjusted odds for dying during the acute hospitalization were 0.87 (95% confidence interval [CI], 0.56-1.36) for health maintenance organization patients, 1.22 (95% CI, 0.55-2.68) for Medicaid patients, 1.25 (95% CI, 0.851.84) for Medicare patients, and 1.21 (95% CI, 0.60-2.44) for self-pay or other patients. The mean length of hospitalization after excluding patients with a prolonged hospitalization was 10.1 days for private or commercial insurance patients, 9.4 days for health maintenance organization patients, 10.9 days for Medicaid patients, 11.1 days for Medicare patients, and 9.8 days for self-pay or other patients. No significant differences in the average duration of hospitalization were seen between the medical insurance groups after controlling for potential confounding variables.
Conclusions
The results of this population-based study suggest that patient insurance status is not significantly associated with either length of hospital stay or short-term mortality following AMI. Other demographic and clinical prognostic factors appear to be more important predictors of short-term outcome in this patient population.
Arch Intern Med. 1997;157:758-762
Author Affiliations
From the Communicable Disease Bureau, Massachusetts Department of Public Health, Boston (Dr Kreindel); Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Goldberg, Yarzebski, Gore, and Russo, Mr Rosetti, and Ms Savageau); and School of Public Health, University of Massachusetts, Amherst (Dr Bigelow).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction
Rahimi et al.
JAMA 2007;297:1063-1072.
ABSTRACT
| FULL TEXT
Insurance Coverage and Care of Patients with Non-ST-Segment Elevation Acute Coronary Syndromes.
Calvin et al.
ANN INTERN MED 2006;145:739-748.
ABSTRACT
| FULL TEXT
Sicker and Poorer--The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income
Hadley
Med Care Res Rev 2003;60:3S-75S.
ABSTRACT
HMO Plan Performance Update: An Analysis Of The Literature, 1997-2001
Miller and Luft
Health Aff (Millwood) 2002;21:63-86.
ABSTRACT
| FULL TEXT
The Association of Sex and Payer Status on Management and Subsequent Survival in Acute Myocardial Infarction
Canto et al.
Arch Intern Med 2002;162:587-593.
ABSTRACT
| FULL TEXT
Hospital Utilization among Chronic Dialysis Patients
ARORA et al.
J. Am. Soc. Nephrol. 2000;11:740-746.
ABSTRACT
| FULL TEXT
Payer Status and the Utilization of Hospital Resources in Acute Myocardial Infarction: A Report From the National Registry of Myocardial Infarction 2
Canto et al.
Arch Intern Med 2000;160:817-823.
ABSTRACT
| FULL TEXT
Managed Care and Outcomes of Hospitalization Among Elderly Patients With Congestive Heart Failure
Ni et al.
Arch Intern Med 1998;158:1231-1236.
ABSTRACT
| FULL TEXT
Insurance Coverage Does Not Influence Post-MI Outcome
Journal Watch Cardiology 1997;1997:12-12.
FULL TEXT
|
