Background Although health maintenance organizations (HMO) are insuring an increasing number of Americans, there are concerns that cost-reduction strategies may limit access to medical care or jeopardize its quality.
This study was conducted to examine the influence of insurance payer status on the process of care and resource utilization among patients hospitalized for congestive heart failure (CHF).
Methods and Results Administrative information on all 1995 New York State hospital discharges assigned ICD-9-CM codes indicative of CHF in the principal diagnosis position were obtained from the Statewide Planning and Research Cooperative System database.
The following were compared among patients with HMO, indemnity, Medicaid fee-for-service, and Medicare fee-for-service insurance coverage : demographics, comorbid illness, process of care, length of stay, hospital charges, mortality rate, and CHF readmission rate.
A total of 43,157 patients were identified (HMO, 1322 ; indemnity, 4350 ; Medicaid, 3878 ; Medicare, 33 607).
Noninvasive procedures were used with similar frequency, whereas greater use of invasive techniques was observed among HMO and indemnity patients.
After adjustment for patient characteristics and hospital type and location, HMO care was associated with shorter length of stay and lower hospital charges, the latter partially explained by fewer hospital days. (...)
Mots-clés Pascal : Insuffisance cardiaque, Homme, Assurance maladie, Qualité, Soin, Etats Unis, Amérique du Nord, Amérique, Compagnie assurance, Appareil circulatoire pathologie, Cardiopathie
Mots-clés Pascal anglais : Heart failure, Human, Health insurance, Quality, Care, United States, North America, America, Insurance company, Cardiovascular disease, Heart disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0438354
Code Inist : 002B12A01. Création : 25/01/1999.