The Relationship Between Managed Care Insurance and Use of Lower-Mortality Hospitals for CABG Surgery

• Published in: JAMA : the journal of the American Medical Association 2000-04, Vol.283 (15), p.1976-1982
• Main Authors: Erickson, Lars C, Torchiana, David F, Schneider, Eric C, Newburger, Jane W, Hannan, Edward L
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Coronary Artery Bypass - economics; Coronary Artery Bypass - mortality; Coronary Artery Bypass - statistics & numerical data; Coronary vessels; Fee-for-Service Plans; Female; Health insurance; Hospital Mortality; Hospitals; Hospitals - statistics & numerical data; Humans; Male; Managed care; Managed Care Programs; Medical sciences; Medicare; Middle Aged; Mortality; Multivariate Analysis; New York; Quality of Health Care; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.283.15.1976

CONTEXT Explicit information about the quality of coronary artery bypass graft (CABG) surgery has been available for nearly a decade in New York State; however, the extent to which managed care insurance plans direct enrollees to the lowest-mortality CABG surgery hospitals remains unknown. OBJECTIVE To compare the proportion of patients with managed care insurance and fee-for-service (FFS) insurance who undergo CABG surgery at lower-mortality hospitals. DESIGN A retrospective cohort study of CABG surgery discharges from 1993 to 1996, using New York Department of Health databases and multivariate analysis to estimate the use of lower-mortality hospitals by patients with different types of health insurance. SETTING Cardiac surgical centers in New York, of which 14 were classified as lower-mortality hospitals (mean rate, 2.1%) and 17 were classified as higher-mortality hospitals (mean rate, 3.2%). PATIENTS A total of 58,902 adults older than 17 years who were hospitalized for CABG surgery. Patients were excluded if their CABG surgery was combined with any valve procedure or left ventricular aneurysm resection or if they were younger than 65 years and enrolled in Medicare FFS or Medicare managed care. MAIN OUTCOME MEASURE Probability of a patient receiving CABG surgery at a lower-mortality hospital. RESULTS Compared with patients with private FFS insurance (n=18,905), patients with private managed care insurance (n=7169) and Medicare managed care insurance (n=880) were less likely to receive CABG surgery at a lower-mortality hospital (relative risk [RR] of surgery at a lower-mortality hospital compared with patients with private FFS insurance, 0.77; 95% confidence interval [CI], 0.74-0.81; P