Practice Short cuts

Medicaid patients miss out on treatments for acute coronary syndrome

BMJ 2006; 333 doi: (Published 30 November 2006) Cite this as: BMJ 2006;333:1164

In the US, the medical care you receive for your acute coronary syndrome depends at least partly on what kind of medical insurance you have. Patients aged under 65 who have “safety net” insurance (Medicaid) seem to do particularly badly, according to an observational study. Compared with patients covered by private insurance or a health maintenance organisation, those relying on Medicaid were less likely to get almost all the recommended drug treatments and less likely to have invasive cardiac procedures including coronary artery bypass grafting (adjusted odds ratio 0.87 (95% CI 0.79 to 0.96)). They also waited longer for treatment.

This poor performance was reflected in the mortality figures, which were significantly higher for patients relying on Medicaid (2.9% v 1.2%, adjusted odds ratio 1.33 (1.08 to 1.63)). Patients aged over 65 who qualified for federally funded Medicare insurance did better. Their care almost matched that received by privately insured patients, and so did their risk of dying.

These observations came from data collected by 521 diverse US hospitals for a quality improvement initiative, so they are not perfect. There are no data on income or education, for example. But the authors managed to adjust for other important differences, including the worse general health associated with having only safety net insurance, and the advantage of private insurance persisted.


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