The quality of care that patients receive in a hospital varies by the type of insurance they have or their lack of insurance, researchers have found in a study in the latest issue of Health Affairs.
Medicare patients, in particular, appeared to receive "notably worse care than patients with private insurance" based on quality indicators from the Agency for Healthcare Research and Quality around eight surgical procedures and seven medical conditions.
[See also: Outcomes matter to hospital supply chain]
"We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for 12 out of 15 quality measures examined," wrote the researchers, led by Christine Spencer, associate professor and executive director of the School of Health and Human Services at the University of Baltimore in Maryland.
However, there were several indicators for which patients with private insurance fared worse than patients in Medicare, Medicaid and other payer groups, the researchers said. Privately insured patients had higher mortality rates for congestive heart failure, stroke and pneumonia.
Mortality rates for Medicare patients ranged from 104 percent higher than private insurance for hip replacement to about 3 percent lower for congestive heart failure, stroke and pneumonia. Nevertheless, in many of the cases where the outcomes of private payers' patients were better, the differences were larger.
So while there is some indication that quality efforts have improved mortality rates for certain conditions, there doesn't seem to be "spillover across payers within a hospital for these targeted conditions," the researchers said in their report.
[See also: Nurse understaffing impacts quality of care, leads to increased infections]
Besides using the AHRQ's Inpatient Quality Indicators, the researchers analyzed State Inpatient Database records for 2006 to 2008 from 11 states, including Arizona, Florida, Iowa, New Jersey, North Carolina and Wisconsin.
Other studies have shown that geographic location, ownership and safety-net status can explain some differences in quality and patient outcomes, but this analysis demonstrates that patient payer type may explain disparities in care quality.
"These findings suggest that public payers and hospitals should diligently measure care quality and monitor treatment patterns for patients with different types of insurance," the researchers concluded.
Some of the differences by payer type that the researchers found may influence outcomes may be due to:
• Patients in the same hospital may not be treated by physicians with the same experience and expertise
• Physician assignment may be related to how a patient is admitted to the hospital and a referring physician's relationship with the surgeon
• Patients who have private insurance may have access to newer technology in their care
• Physicians of privately insured patients may be able to monitor them more carefully, such as through electronic health record systems or more personalized treatment
• Possible difference in coding practices to construct risk-adjusted rates.