HEALTH-INSURANCE COVERAGE AND OUTCOME FOLLOWING ACUTE MYOCARDIAL-INFARCTION - A COMMUNITY-WIDE PERSPECTIVE

Background: Several studies have suggested that type of medical insura nce coverage is associated with hospital utilization rates and receipt of selected diagnostic or treatment approaches. To our knowledge no s tudies, however, have examined the relation between medical insurance coverage and short-term outcomes following acute myocardial infarction (AMI) from a multihospital, community-wide perspective. Objective: To examine the association between medical insurance coverage and in-hos pital case-fatality rates as well as length of hospital stay following AMI. Methods: The study sample consisted of 3735 residents of the Wor cester, Mass, metropolitan area hospitalized with validated AMI during 1986, 1988, 1990, 1991, and 1993 at all metropolitan Worcester hospit als. Data were obtained from the review of medical records. Patients w ere stratified into 5 medical insurance groups for purposes of analysi s: private or commercial(n=711), Medicaid (n=101), Medicare (n=1991), health maintenance organization (n=741), and self-pay or other (n=191) . Crude and multivariable-adjusted analyses were used to examine the r elation between medical insurance coverage and length of hospital stay and in-hospital case-fatality rates following AMI. Results: In-hospit al case-fatality rates during the period under study were 7.7%, 11.9%, 21.4%, 9.3%, and 10.0% the 5 medical insurance groups, respectively. After adjusting for several factors that may affect in-hospital mortal ity, relative to the referent group of private or commercial insurance patients (odds ratio, 1.0), the multivariable-adjusted odds for dying during the acute hospitalization were 0.87 (95% confidence interval [ CI], 0.56-1.36) for health maintenance organization patients, 1.22 (95 % CI, 0.55-2.68) for Medicaid patients, 1.25 (95% CI, 0.85-1.84) for M edicare patients, and 1.21 (95% CI, 0.60-2.44) for self-pay or other p atients. The mean length of hospitalization after excluding patients w ith a prolonged hospitalization was 10.1 days for private or commercia l insurance patients, 9.4 days for health maintenance organization pat ients, 10.9 days for Medicaid patients, 11.1 days for Medicare patient s, and 9.8 days for self-pay or other patients. No significant differe nces in the average duration of hospitalization were seen between the medical insurance groups after controlling for potential confounding v ariables. Conclusions: The results of this population-based study sugg est that patient insurance status is not significantly associated with either length of hospital stay or short-term mortality following AMI. Other demographic and clinical prognostic factors appear to be more i mportant predictors of short-term outcome in this patient population.