Payer Status Affects Health Care Quality and Outcomes

Heart failure patients without private insurance/HMO have poorer care, worse outcomes

TUESDAY, Sept. 20 (HealthDay News) -- Patients with heart failure who have no insurance, or have Medicaid or Medicare, have lower quality of care and worse outcomes than those with private/health maintenance organization (HMO) insurance, according to a study published in the Sept. 27 issue of the Journal of the American College of Cardiology.

John R. Kapoor, M.D., Ph.D., from the University of Chicago Pritzker School of Medicine, and colleagues investigated the association of payment source with health care quality and in-hospital outcomes in 99,508 admissions with heart-failure from 244 sites between 2005 and 2009. Patients were stratified by payer status (Medicare, Medicaid, no insurance, and private/HMO), and private/HMO was the reference group.

The investigators found that compared to the private/HMO group, those in the no insurance group had lower odds of receiving evidence-based beta-blockers (odds ratio [OR], 0.73), implantable cardioverter-defibrillators (OR, 0.59), or anticoagulation for atrial fibrillation (OR, 0.73). Compared to the reference groups, patients in the Medicaid group were less likely to receive evidence-based beta-blockers (OR, 0.86) or implantable cardioverter-defibrillators (OR, 0.86), and those in the Medicare group were prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers less often (OR, 0.89). Longer hospital stays were observed for the Medicare, Medicaid, and no-insurance groups. Patients with Medicaid (OR, 1.22) and those with reduced systolic function with no insurance had higher rates of in-hospital mortality.

"Decreased quality of care and outcomes for patients with heart failure were observed in the no-insurance, Medicaid, and Medicare groups compared with the private/HMO group," the authors write.

Several of the study authors disclosed financial ties to the pharmaceutical and biomedical device industries.

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