Payer status and the utilization of hospital resources in acute myocardialinfarction - A report from the National Registry of Myocardial Infarction 2

Background: Prior studies have suggested that payer status may be an import ant determinant of medical resource utilization and outcome in acute myocar dial infarction (AMI). Methods: A national cohort of 332 221 patients with AMI enrolled from June 1994 to July 1996 were compared within 5 payer groups to ascertain the infl uence of payer status on hospital resource allocation for AMI in the United States. Results: Medicare comprised the largest proportion (56%), followed by comme rcial insurance (25%), health maintenance organization (HMO) (10%), uninsur ed (6%), and Medicaid (3%). Compared with commercially insured patients, Me dicare and Medicaid patients received fewer reperfusion therapies, underwen t fewer invasive cardiac procedures, and had longer hospitalizations. After adjusting for differences in clinical characteristics, Medicare recipients were as likely as commercially insured patients to receive acute reperfusi on therapies or any invasive cardiac procedure. Uninsured and HMO patients tended to utilize hospital resources with intermediate frequency. Medicare recipients aged 65 years or older and the HMO group had similar hospital mo rtality rates compared with the commercial group (odds ratio [OR], 1.07; 95 % confidence interval [CI], 0.96-1.20 and OR, 0.93; 95% CI, 0.83-1.04, resp ectively),but Medicaid and uninsured groups had higher hospital mortality r ates compared with the commercial group (OR, 1.30; 95% CI, 1.14-1.48 and OR , 1.29; 9546 CI, 1.12-1.48, respectively). Conclusion: This report suggests significant variation by payer status in t he management of AMI throughout the United States, but no important differe nces in mortality among the 3 largest payer groups.