The quality of care patients receive may depend on the type of insurance they have, even when variations in facility-level factors like geography and ownership are accounted for. The findings, released in the October 2013 issue of Health Affairs, suggest that after data are adjusted for risk, privately insured patients have lower mortality rates than their Medicare-enrolled counterparts, even when these patients were treated in the same hospital.
The findings are based on an analysis of State Inpatient Database records of hospital discharges in Arizona, California, Florida, Iowa, Maryland, Massachusetts, New Jersey, New York, North Carolina, Washington, and Wisconsin—a diverse sample that represents nearly 39% of the country's acute care discharges. Records from 1,434 hospitals were reviewed in the study, which focused on 8 surgical procedures and 7 medical conditions.
Researchers found that privately insured patients had lower mortality rates than Medicare patients in 12 of the 15 selected procedures or conditions. For instance, Medicare patients had a 104% higher mortality rate than the privately insured for hip replacement and a 22% higher rate of mortality for hip fractures. Medicare patients showed lower mortality rates in stroke, congestive heart failure, and pneumonia, but the differences were smaller.
The study cites no clearcut reason for why Medicare patients would have higher mortality rates than patients with private insurance, but the authors suggest that some of the inequality may have to do with the ways attending physicians are assigned, the availability of referral networks, unequal access to newer technologies, and possible overcoding of premorbidities for private insurance patients. The report recommends that "to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals." A report on the findings appeared in Medscape on October 8.
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