Medicaid patients had higher in-hospital mortality rates (2.9% vs. 1.2%) and after adjustment, the risk for death was approximately 30% higher in Medicaid patients compared to those with HMOs and private insurances. Mortality rates were not significantly different for Medicare patients.
"It is reassuring to find that the Medicare system for our older Americans appears to be working, but disappointing to find insurance status affects quality of care and clinical outcomes for cardiac patients under the age of 65," said Calvin.
The study urges more investigation to determine the root cause of these disparities and develop novel strategies for narrowing the gaps in quality. According to Calvin, it's not simply an issue of economic gain.
"On the surface people may conclude that doctors have a bias against poor people. However, it doesn't cost a thing to tell someone to watch the salt in their diet or to quit smoking, which is really good advice to reduce heart problems," said Calvin. "We need further study to determine if system problems, such as lack of computerized record keeping or not enough nurses contribute to this disparity. Care by a non-cardiologist may also be partly responsible."
The patients evaluated in the study were from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early implementation of the ACC/AHA guidelines) quality improvement initiative. Data was collected from January 2001 through March of 2005.