Market reform in New Jersey and the effect on mortality from acute myocardial infarction.
Market reform in New Jersey and the effect on mortality from acute myocardial infarction.
复制标题
新泽西州的市场改革及其对急性心肌梗死死亡率的影响。
DOI：
10.1111/1475-6773.00131
复制
发表时间：
2003
影响因子：
3.4
通讯作者：
Pauly,MarkV
中科院分区：
文献类型：
--
作者：
Volpp,KevinGM;Williams,SankeyV;Waldfogel,Joel;Silber,JeffreyH;Schwartz,JSanford;Pauly,MarkV
目的：确定新泽西实施《医疗保健改革法》后急性心肌梗死（AMI）患者的死亡率是否发生变化，该法案减少了对未投保者的住院护理补贴，并将医院支付从基于医院成本的费率设定系统改为价格竞争。研究背景：1990年至1996年新泽西和纽约医院患者出院数据和医疗保健成本和利用项目（HCUP）全国住院患者样本（NIS）研究设计：一项在不同州之间进行的未经校正和风险校正的死亡率和心脏手术率的比较。数据收集：从1990年到1996年，收集了286，640例在新泽西或纽约医院住院的初步诊断为AMI的患者的出院数据。364，273例NIS患者的记录被用来证实时间趋势。主要发现：相对于纽约或NIS，新泽西保险患者的AMI死亡率没有显著差异。然而，有一个相对增加的死亡率为41%至57%之间的无保险的新泽西患者改革后，他们的价格昂贵的心脏程序concomitant.Conclusions下降，引入医院的价格竞争和减少补贴的医院护理的无保险的与无保险的新泽西AMI患者的死亡率增加。新泽西心脏手术的使用相对减少可能部分解释了这一发现。应进行更多的研究，以确定其他市场改革是否与护理质量的变化有关。
Objective.To determine whether mortality rates for patients with acute myocardial infarction (AMI) changed in New Jersey after implementation of the Health Care Reform Act, which reduced subsidies for hospital care for the uninsured and changed hospital payment to price competition from a rate‐setting system based on hospital cost.Data Sources/Study Setting.Patient discharge data from hospitals in New Jersey and New York from 1990 through 1996 and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS).Study Design.A comparison between states over time of unadjusted and risk‐adjusted mortality and cardiac procedure rates.Data Collection.Discharge data were obtained for 286,640 patients with the primary diagnosis of AMI admitted to hospitals in New Jersey or New York from 1990 through 1996. Records of 364,273 NIS patients were used to corroborate time trends.Principal Findings.There were no significant differences in AMI mortality among insured patients in New Jersey relative to New York or the NIS. However, there was a relative increase in mortality of 41 to 57 percent among uninsured New Jersey patients post‐reform, and their rates of expensive cardiac procedures decreased concomitantly.Conclusions.The introduction of hospital price competition and reductions in subsidies for hospital care of the uninsured were associated with an increased mortality rate among uninsured New Jersey AMI patients. A relative decrease in the use of cardiac procedures in New Jersey may partly explain this finding. Additional studies should be done to identify whether other market reforms have been associated with changes in the quality of care.