MONDAY, Sept. 19 (HealthDay News) -- The quality of care people
with heart failure receive, along with outcomes, are significantly
influenced by what type of insurance patients have, a new study
Medicare and Medicaid patients and those without health
insurance are less likely to be given some essential treatments and
tend to be hospitalized longer, researchers report. Medicaid
patients were 22 percent more likely to die in the hospital than
patients with private insurance, the researchers said.
"I wish the results revealed a different story," said lead researcher Dr. John R. Kapoor, an assistant professor of medicine at the University of Chicago Pritzker School of Medicine.
The findings reveal that disparities in heart failure care do
exist and are associated with worse outcomes, he added, and these
unequal practices should be corrected.
"It remains medicine's major unhealed wound that care continues to be tailored to individuals based on their pocketbook, and not their condition," he said. "Quality of care for all patients --- insured and uninsured -- is priceless."
The report will be published in the Sept. 27 issue of the
Journal of the American College of Cardiology.
For the study, Kapoor's team collected data on 99,508 heart
failure patients seen in 244 hospitals that are part of the
American Heart Association's Get with the Guidelines Heart Failure
The researchers found that, even among these hospitals,
insurance coverage had an influence on how the guidelines were
For example, compared with privately insured patients, patients
with Medicaid or no insurance were less likely to be given blood
pressure drugs called beta blockers or have an implantable
cardioverter-defibrillator prescribed or placed before leaving the
hospital. A cardioverter-defibrillator automatically delivers a
shock to the heart if the heart starts beating irregularly, to
return the heartbeat to normal.
Other drugs that are part of the guidelines for treating heart
failure were also less likely to be prescribed to those with
Medicaid or no insurance, Kapoor's group found.
In addition, Medicaid and Medicare patients were also less
likely to receive other blood pressure medication such as
angiotensin-converting enzyme (ACE) inhibitors or angiotensin
receptor blockers (ARBs) and beta blockers, compared with privately
insured patients, the researchers found.
Study co-author Dr. Gregg Fonarow, a professor of cardiology at
the University of California, Los Angeles, said there are many
reasons for the disparities in quality of care based on who is
paying the bill.
"Inequalities in access to specialist care during hospital admissions may explain some of the differences by insurance status," Fonarow said. "There may also be a bias among certain physicians and hospitals to not prescribe medications or therapies with life-prolonging benefits to patients based on whether the patient is well-insured or not. Patient insurance status is also correlated with socioeconomic status, which may in turn also influence care and outcomes."
"These shocking and equally disturbing findings call for physicians to pause and reflect on practice behaviors," Kapoor said. "Quality care should be a priority, irrespective of financial incentives."
Dr. Marvin Konstam, director of the CardioVascular Center at
Tufts Medical Center in Boston and author of an accompanying
journal editorial, said there are "blatant" examples throughout the
health care system in which patients don't get proven therapies
because they lack adequate insurance coverage.
He cited a decision in Arizona to halt paying for several types
of organ transplants for Medicaid recipients.
"That's a decision that has since been rescinded, but that's an example of how in the current system there is a very great risk of making misguided arbitrary decisions and cutting off whole segments of the population from a proven therapy," he said.
That can range from decisions made by individual doctors for a
particular patient all the way up to state and federal governments
making decisions on whole classes of treatments, he said.
Konstam thinks decisions on care need to take into account the
cost-effectiveness of therapies, not just the cost of the therapy
itself. In addition, payment for care needs to be changed to make
costs similar for patients across the board.
For more on heart failure, visit the
U.S. National Library of Medicine.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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