Increased heart mortality rates linked to lower state subsidies of uninsured in New Jersey

(Philadelphia, PA) -- The introduction of market-based competition to New Jersey's hospitals and the state's reduction in subsidies for uninsured medical care have been linked to a relative increase in mortality rates among uninsured heart attack patients there, in a study at the University of Pennsylvania School of Medicine that compares New Jersey patient data with similar national and New York State statistics.

The Penn researchers analyzed data on 286,640 heart attack patients who were admitted to hospitals in New Jersey and New York from 1990 through 1996 -- a period in which the New Jersey health care system underwent dramatic financial reforms and cut by 50 percent its hospital subsidies for the care of uninsured patients.

They found that while mortality rates for uninsured hospital patients suffering from acute myocardial infarctions (AMIs) in New York dropped from 12 percent to 8 percent by 1996, mortality rates for New Jersey's uninsured patients increased from 7.8 percent in 1992 to 8.3 percent over the same period. During that time, the use of beneficial cardiac procedures increased at a much higher rate for New York's uninsured patients than for New Jersey's uninsured patients.

Mortality rates for insured patients declined at the same rate in both states.

"Although market-based reforms in medicine are becoming more widespread, little is known about how they affect quality-of-care," said Kevin Volpp, MD, PhD, the principal investigator for the study. He is an Assistant Professor of Internal Medicine at Penn, the Philadelphia Veterans Affairs Medical Center, and the Department of Health Care Systems at the Wharton School.

"The effects of the change in hospital reimbursement that we observed in this study represent only one segment of the patient population in one state, but may be an indication that we need to pay close attention to how cost-saving reforms may affect the quality of care across the country," Volpp

Contact: Ellen O'Brien
University of Pennsylvania School of Medicine

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