Not All Insurance Is Equal: Differential Treatment and Health Outcomes by Insurance Coverage Among Nonelderly Adult Patients With Heart Attack
Not All Insurance Is Equal: Differential Treatment and Health Outcomes by Insurance Coverage Among Nonelderly Adult Patients With Heart Attack
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DOI：
10.1161/jaha.117.008152
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发表时间：
2018-06-05
影响因子：
5.4
通讯作者：
Shen, Yu-Chu
中科院分区：
文献类型：
--
作者：
Niedzwiecki, Matthew J.;Hsia, Renee Y.;Shen, Yu-Chu
背景-《平价医疗法案》为美国很大一部分未参保的人提供了医疗保险。然而，不同类型的医疗保险向提供者提供不同数额的报销，这可能导致不同类型的治疗，可能会恶化医疗补助等低报销保险计划覆盖的患者的健康结果。研究的目的是利用医院固定效果，确定不同保险类型在获取、治疗和健康结果方面的差异。方法和结果-我们使用2001年1月1日至2014年12月31日加州非老年成年急性心肌梗死患者水平的数据以及医院水平的信息进行多元回归分析，以控制不同医院之间的差异。与私人参保的患者相比，医疗补助参保和未参保的患者获得导尿实验室的可能性分别高出4.50和3.75个百分点。然而，在控制使用经皮冠状动脉介入治疗设施时，与私人保险患者相比，医疗补助保险和未保险患者接受经皮冠状动脉介入治疗的概率分别低4.24和0.85个百分点。与私人保险的患者相比，他们的死亡率和再住院率也更高。结论--尽管医疗补助和非保险的急性心肌梗死患者更容易进入导管实验室，但他们接受经皮冠状动脉介入治疗的概率显著低于私人保险的患者，死亡和再入院的可能性高于私人保险的患者。这提供了经验证据，表明医疗补助参保、未参保和私人参保的患者所接受的治疗和健康结果存在很大差异，其中医疗补助参保患者受到的影响最大，尽管他们更容易获得心脏技术。
Background-The Affordable Care Act has provided health insurance to a large portion of the uninsured in the United States. However, different types of health insurance provide varying amounts of reimbursements to providers, which may lead to different types of treatment, potentially worsening health outcomes in patients covered by low-reimbursement insurance plans, such as Medicaid. The objective was to determine differences in access, treatment, and health outcomes by insurance type, using hospital fixed effects.Methods and Results-We conducted a multivariate regression analysis using patient-level data for nonelderly adult patients with acute myocardial infarction in California from January 1, 2001, to December 31, 2014, as well as hospital-level information to control for differences between hospitals. The probability of Medicaid-insured and uninsured patients having access to catheterization laboratory was higher by 4.50 and 3.75 percentage points, respectively, relative to privately insured patients. When controlling for access to percutaneous coronary intervention facilities, however, Medicaid-insured and uninsured patients had a 4.24- and 0.85-percentage point lower probability, respectively, in receiving percutaneous coronary intervention treatment compared with privately insured patients. They also had higher mortality and readmission rates relative to privately insured patients.Conclusions-Although Medicaid-insured and uninsured patients with acute myocardial infarction had better access to catheterization laboratories, they had significantly lower probabilities of receiving percutaneous coronary intervention treatment and a higher likelihood of death and readmission compared with privately insured patients. This provides empirical evidence that treatment received and health outcomes strongly vary between Medicaid-insured, uninsured, and privately insured patients, with Medicaid-insured patients most disproportionately affected, despite having better access to cardiac technology.