To investigate the importance of the payer in the utilization of in-hospital cardiac procedures, we examined the care of 37,994 patients with Medicaid, private insurance, or no insurance who were admitted to Massachusetts hospitals in 1985 with circulatory disorders or chest pain. Using logistic regression to control for demographic, clinical, and hospital factors, we found that the odds that privately insured patients received angiography were 80% higher than uninsured patients; the odds were 40% higher for bypass grafting and 28% higher for angioplasty. Medicaid patients experienced odds similar to those of uninsured patients for receiving angiography and bypass, but had 48% lower odds of receiving angioplasty. In addition, the odds for Medicaid patients were lower than for privately insured patients for all three cardiac procedures. These findings suggest that insurance status is associated with the utilization of cardiac procedures. Future studies should determine the implications these findings have for appropriateness and outcome and whether interventions might improve care.
KIE: This study evaluated the effect of insurance status on the utilization of three widely used and expensive cardiac procedures: coronary angiography, bypass grafting, and angioplasty. Data were obtained from records for all patients with circulatory disorders who were discharged from nonfederal acute care hospitals in Massachusetts during 1985. Analysis of the data revealed that unadjusted procedure rates for privately insured patients were approximately twice the rates for Medicaid and uninsured patients. The latter two groups of cardiac patients underwent procedures at about the same rate. Wenneker, et al. discuss possible reasons for the differences in utilization of cardiac procedures among the three groups of patients. They conclude that their findings raise serious questions about the quality of care for patients with heart disease in the context of payer status, and that further study of the issue is needed.