Managed Care Fails Hearts
Managed care insurance leaves patients with no
choice and a higher chance of death

Researchers say that heart bypass patients covered by managed care insurance plans were less likely to be sent to better quality hospitals, where fewer people died after such procedures. (PhotoDisc)

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 today.
"An excellent 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.
Compared with 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.
The report was published in this week's Journal of the American Medical Association.

Patients Need More Control
"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 report.
"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...
"Financial risk 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.
Conditions vary 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 them."
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 sources."
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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