Medicaid, managed care, and the care of patients hospitalized for acute myocardial infarction

Background TennCare, beginning in January 1994, channeled all Medicaid-elig ible patients into managed core while expanding Medicaid coverage to large numbers of previously uninsured patients. We assessed the impact of TennCar e on (1) coronary revascularization of patients who had had an acute myocar dial infarction (AMI), (2) the likelihood of the patient having a usual pro vider of care after discharge from the hospital, and (3) health and functio nal status 1 to 3 years after the index AMI. Methods and Results with the use of 1996 to 1997 survey data from 438 patie nts hospitalized for AMI in 1993 and 1995 who were under age 65 years at th e index admission, multivariate analysis was used to calculate effects of T ennCare on utilization and outcomes. TennCare patients were as likely as pr ivately insured patients to have received coronary revascularization within 30 days of the index AMI (odds ratio 0.87, P = .69). Persons enrolled in T ennCare and in traditional Medicaid who received a revascularization proced ure were much less likely to have received coronary angioplasty than corona ry bypass surgery than were the privately insured (TennCare: odds ratio 0.3 7, P = .05; Medicaid: odds ratio 0.28, P = .08). Virtually all TennCare enr ollees (94%) reported having a usual provider of care in the year before th e survey versus 85% for privately insured patients with AMI in 1995 (P = .0 5). On health and functional status, TennCare enrollees overall fared as we ll as those with private insurance. Conclusions Our results suggest that TennCare brought patients who otherwis e would have been uninsured or enrolled in Medicaid into the medical mainst ream, measured both in terms of utilization of services and health and func tional status.