POTENTIALLY AVOIDABLE REHOSPITALIZATIONS FOLLOWING ACUTE MYOCARDIAL INFARCTION BY INSURANCE STATUS

• Published in: Journal of community health 2003-06, Vol.28 (3), p.167-184
• Main Authors: García, Jorge A., Yee, Martin C., Chan, Benjamin K. S., Romano, Patrick S.
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Ambulatory care; Ambulatory Care - standards; Attrition (Research Studies); California - epidemiology; Cardiovascular disease; Chronic Disease; Community Relations; Comorbidity; Female; Health care access; Health insurance; Health Services Accessibility - economics; Health Services Accessibility - statistics & numerical data; Health Services Research; Heart attacks; Hospitalization; Hospitals; Humans; Illnesses; Insurance Coverage - classification; Insurance Coverage - statistics & numerical data; Internal medicine; Male; Medicaid; Medicaid - statistics & numerical data; Medical records; Medically Uninsured - statistics & numerical data; Medicare; Medicare - statistics & numerical data; Medicine; Middle Aged; Mortality; Multivariate Analysis; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - economics; Myocardial Infarction - prevention & control; Myocardial Infarction - therapy; Outcome Assessment (Health Care); Patient Readmission - economics; Patient Readmission - statistics & numerical data; Patients; Periodicals; Probability; Public Health; Records (Forms); Retrospective Studies; Risk Factors; Severity of Illness Index; Uninsured people; Validity
• ISSN: 0094-5145; 1573-3610
• DOI: 10.1023/A:1022904206936

Few studies have explored the impact of health insurance on patients with severe, chronic diseases. This retrospective study examined the association between health insurance and the risk of potentially avoidable rehospitalization in the 3 years following validated acute myocardial infarction (AMI) for a community-based probability sample of 683 patients admitted to 30 California hospitals in 1990-1991. In a multivariate analysis adjusted for measures of comorbidity burden, severity of illness, and AMI-related inpatient care, the risk of readmission was not significantly different among patients with no insurance, Medicare insurance, and non-Medicaid, non-Medicare ("private or other") insurance. However, compared to the latter group, patients with Medicaid were 2.6 times more likely to be readmitted for an AMI-related process (risk ratio, 2.61; 95% confidence interval, 1.33 to 5.11). Additional studies are needed to define the role of health insurance on clinical outcomes and health care access across a broader range of conditions and communities.