UNEQUAL CLINICAL PROFILE, QUALITY-OF-LIFE AND SURGICAL MORTALITY IN PUBLIC AND PRIVATE PATIENTS UNDERGOING CORONARY-BYPASS SURGERY IN CATALONIA

Introduction and aims. The influence of the type of health care fundin g and management of hospital centres on hospital mortality in coronary artery bypass surgery (CABG) has not been analyzed in detail. We ther efore assessed clinical and quality of life preoperative profiles and in-hospital mortality in public and private patients undergoing corona ry bypass surgery in Catalonia. Methods. Clinical questionnaires, Duke Activity Status Index (DASI) and SF-36 were preoperatively administer ed to all patients undergoing first coronary bypass surgery without as sociated procedures in Catalonia between November 1996-June 1997. In-h ospital morbidity and mortality were recorded. Results. Predictors of in-hospital death, including DASI, SF-36 and comorbidity scores, were significantly worse in public than in private patients. In-hospital mo rtality rate was more than ten times greater in public than in private patients (8.2% vs 0.7%; p < 0.001). Multivariate analysis identified private funding of health care, among others, as an independent predic tor of in-hospital survival. Non evidence-based indications for surger y were significantly more common in private than in public patients (6 % vs 0.7%, p < 0.001). Conclusions. a) In Catalonia, the risk profile of public patients undergoing coronary bypass surgery was significantl y higher than that of private patients, accounting, at least in part, for a remarkable mortality difference; b) non evidence-based indicatio ns for surgery were more common in private than in public patients; c) these unequal patterns raise questions about the adequacy of care and referral patterns in both private and public sectors.