INSURANCE TYPE AND THE TRANSPORTATION TO EMERGENCY DEPARTMENTS OF PATIENTS WITH ACUTE CARDIAC ISCHEMIA - THE ACI-TIPI TRIAL INSURANCE STUDY

The relationship of insurance type to treatment-seeking behavior (ie, the transportation to emergency departments of patients with symptoms suggestive of acute cardiac ischemia) was evaluated. The focus was on comparing patients belonging to a health maintenance organization (HMO ) with patients who had indemnity insurance. Data were collected prosp ectively on 10,783 patients presenting to emergency departments of 10 adult care hospitals in the Eastern and Midwestern United States betwe en April and December 1993 as part of a clinical trial. A total of 6,6 04 patients presented within 24 hours of symptom onset. Although these patients as a group had a wide range of demographic and clinical char acteristics, persons belonging to an HMO and those with indemnity insu rance were very similar. The main outcome measures were whether the pa tient was transported by ambulance and the duration of time from sympt om onset to emergency department arrival. A hospital-matched sample of HMO-insured and indemnity-insured patients allowed multivariable regr ession: HMO membership was not associated with a different rate of amb ulance use (odds ratio = 1.0; 95% confidence interval = 0.73, 1.35) or duration of time from symptom onset to emergency department presentat ion (6 minutes less, P = 0.8). HMO participation was not related to tr eatment-seeking behavior, as reflected by ambulance use and duration o f time from symptom onset to emergency department arrival. However, st udies of more constrained managed care organizations and of broader ra nges of patients are needed.