Privately insured heart patients had best treatment outcomes

Patients who had heart valve replacement surgery who were privately insured had better medical outcomes than the uninsured and Medicaid patients undergoing the same procedure, researchers said on Friday.

As a result, the type of primary insurance should be considered an independent risk factor as patients and doctors weigh risks for surgery, they concluded.

The study, published in the Journal of the American College of Surgeons, found that uninsured and Medicaid status independently increased the risk of in-hospital mortality and the likelihood of complications after the surgery. This was true even after accounting for socioeconomic status, hospital-related and other factors associated with low-income patient groups, they said.

In addition, Medicaid patients accrued the longest average hospital stay and highest total costs.

"The study findings indicate that primary payer status should be considered as an independent risk factor during preoperative patient risk evaluation," said the study's lead author, Dr. Damien LaPar of the University of Virginia Health System.

From 2007 to 2008, the number of uninsured Americans rose by 600,000. Patients covered by Medicaid and Medicare, the U.S. government assistance insurance programs, increased by 4.4 million, while the number of Americans covered by private health insurance fell by 1 million.

Previous research has shown that Medicaid and uninsured patients have worse outcomes than privately insured patients after medical admissions.

While there have been studies on insurance status as a predictor of disease and the differences in allocation of surgical treatment as a function of the type of insurance a patient has, no study has fully examined the impact of the type of insurance on patients undergoing cardiac valve procedures, nor have they been evaluated in a national database, researchers noted.

The study examined 477,932 patients undergoing heart valve operations over a six-year period using discharge data from the Nationwide Inpatient Sample database.

Patients in each payer group had different income and risk factors. After adjusting for risk factors, the type of insurance a patient had remained a highly significant predictor of mortality, they said.