THURSDAY, June 10 (HealthDay News) -- A large new study suggests
that surviving a hospitalization for heart attack, stroke or
pneumonia may depend, at least in part, on the type of insurance
you have.
The death risk from these common medical conditions is
significantly higher for working-age Americans who are uninsured or
on Medicaid than for privately insured patients, researchers have
found.
For every 100 heart attack patients, for example, the
in-hospital death rate was 2.22 percent for privately insured
patients, versus 4.03 percent for the uninsured, the study
found.
"The most important thing to consider is that even one excess death among a hundred heart attack patients, which may be related to being uninsured, is one too many," said lead author Dr. Omar Hasan, a Harvard Medical School instructor and a hospitalist at Brigham & Women's Hospital in Boston.
The study did not reveal the reasons for such disparities in
care, although Hasan suspects a combination of factors, such as
provider sensitivity to insurance status and uninsured patients'
limited access to primary care. He also cited studies showing that
people who are uninsured are less likely to undergo high-cost
medical procedures, such as heart bypass surgery.
American Heart Association president Dr. Clyde Yancy urged
caution in interpreting the findings, noting that access to care
and quality of care are not the same thing.
"We have to understand that what constitutes very good care, high quality care, begins with access, but it doesn't end there," said Yancy, who is also medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas.
Outcomes are driven by multiple factors, such as the
practitioner, institution and patient mix, he explained.
Numerous studies have focused on insurance-related disparities
in outpatient settings, but very few examine gaps in the quality of
inpatient hospital care, the authors noted in their paper,
published in the
Journal of Hospital Medicine.
Hasan and colleagues analyzed data from more than 150,000
hospital discharges involving adults ages 18 to 64. The cases were
culled from over 1,000 hospitals across 37 states in 2005.
Compared with privately insurance patients, hospital deaths from
heart attack and stroke were significantly higher for uninsured and
Medicaid patients. Based on the death rates in the study, Hasan
estimated that uninsured heart attack and stroke patients faced a
50 percent and 44 percent higher risk of dying, respectively, than
the privately insured.
The in-hospital death rate for Medicaid patients with pneumonia
was also significantly higher (a 21 percent rise) than for people
with insurance, the study found.
The higher death rates remained even after researchers adjusted
for various patient characteristics, including severity of
illness.
Medicaid recipients had longer lengths of stay for all three
conditions, while hospital costs were higher for Medicaid
recipients hospitalized for stroke and pneumonia.
Hasan believes that the passage of health reform legislation
earlier this year creates new opportunities to improve the quality
of health-care delivery, however.
"Policymakers and administrators should take steps to ensure that equity in health-care delivery is appropriately measured and [that] reducing insurance-related gaps in quality remains the focus of quality improvement efforts," he said.
Yancy cited the American Heart Association's own hospital-based
quality improvement program, called "Get With The Guidelines," as
an example of the type of initiative in addition to expanding
access to care that is needed to maximize outcomes.
More information
There's more on finding good hospital care at the
Hospital Quality Alliance.