|By Michael Colon
C H I
C A G O, April 18 —A study of heart bypass
patients has found that those covered by managed care insurance plans were
less likely to be sent to better quality hospitals, where fewer people
died after such procedures, researchers reported
take-home message (from this study) is that patients and doctors need to
take control back,” said Lars Erickson of Children’s Hospital in Boston,
chief author of the report.
“They need to use
information that has been painstakingly collected by the state (on
hospital quality). The problem with managed care is that you have to make
that decision when you sign up. You can’t wait until you’re sick,” he said
in an interview.
The study looked at 58,902
patients hospitalized for coronary artery bypass surgery in New York state
from 1993 to 1996. It did not track what happened to those patients but it
did show which hospitals they were sent to, hospitals which Erickson said
had specifically been ranked as high- or low-mortality institutions based
on bypass surgery outcomes.
patients with private fee-for-service insurance, patients with private
managed care insurance, which usually specifies which hospital and doctor
can be used, were 23 percent less likely to receive the surgery at a
lower-mortality hospital, the study found. Medicare managed care insurance
patients undergoing the same procedure were 39 percent less likely to have
it at a lower mortality hospital.
was published in this week’s Journal of the American Medical
Patients Need More
“By limiting patient choices, managed
care organizations may prevent patients and their advocates from taking
full advantage of available information about hospital quality,” said the
“This could inadvertently stifle
incentives for hospitals to compete on the quality of care,” it added.
“Additional studies on the impact of quality information on health plans’
contracting decisions will be important as price competition among health
plans becomes more intense…
provides a strong incentive for health plans to select low-priced
hospitals. However, health plans should also consider quality of care when
contracting with hospitals, especially if explicit data on quality are
available,” the study said.
from state to state, and non-insurance factors also influence where
patients seek care; but Erickson told Reuters: “One thing that is very
clear is that if people don’t start taking an active role in figuring out
which hospital is best for them, those choices are being taken away from
In an editorial in the same issue
commenting on the study, Stephen Jencks of the federal government’s Health
Care Financing Administration said a number of studies have found that
patients “rank quality information far behind convenience, coverage,
access, and cost in choosing health plans … consumers make clear that they
value information on health choices from friends, family, and personal
physicians much more than information from government
But he said information on quality
must be made available even though it probably will not “reshape the
marketplace in the short run.”
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