EXPECTED SOURCE OF PAYMENT AND USE OF HOSPITAL SERVICES FOR CORONARY ATHEROSCLEROSIS

To study associations between payer and provision of services for pati ents hospitalized for coronary atherosclerosis, the authors analyzed a bstracts of 24,424 discharges from California acute care hospitals dur ing 1989. Services examined included receipt of coronary artery bypass surgery, percutaneous transluminal coronary angioplasty (PTCA), long length of stay (LOS) without revascularization, and overall LOS. Regre ssion techniques controlled demographic factors and comorbidities. The privately insured were 96% more likely to undergo revascularization ( either bypass or PTCA) than Medicaid discharges and 117% more likely t han the uninsured. Odds of revascularization for Medicare and health m aintenance organization discharges resembled those for the privately i nsured. Analyzed separately, PTCA was far more likely among the privat ely insured than Medicaid beneficiaries and the uninsured. In addition , the adjusted odds for PTCA were 52% greater for the privately insure d than for health maintenance organization discharges. The greatest li kelihood of long LOS without revascularization and the greatest overal l LOS was observed for Medicaid discharges. Strong associations, consi stent with financial incentives to provide care, exist between payer a nd provision of services. Future Studies need to address whether varia tions in process result from differences in thresholds for procedure p erformance, differences in admission practices, or both.