title: Influence of payor on use of invasive cardiac procedures and patient outcome after myocardial infarction in the United States. Participants in the National Registry of Myocardial Infarction.
abstract: OBJECTIVE
  We sought to determine the influence of payor status on the use and appropriateness of cardiac procedures.
  
  
  BACKGROUND
  The use of invasive procedures affects the cost of cardiovascular care and may be influenced by payor status.
  
  
  METHODS
  We compared treatment and outcomes of myocardial infarction among four payor groups: fee for service (FFS), health maintenance organization (HMO), Medicaid and uninsured. Multivariate comparison was performed on the use of invasive cardiac procedures, length of hospital stay and in-hospital mortality in 17,600 patients <65 years old enrolled in the National Registry of Myocardial Infarction from June 1994 to October 1995. To determine the appropriateness of coronary angiography, we compared its use in patients at low and high risk for cardiac events.
  
  
  RESULTS
  Angiography was performed in 86% of FFS, 80% of HMO, 61% of Medicaid and 75% of uninsured patients. FFS patients were more likely to undergo angiography than HMO (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.13 to 1.42), Medicaid (OR 2.43, 95% CI 2.11 to 2.81) and uninsured patients (OR 1.99, 95% CI 1.76 to 2.25). Similar patterns for the use of coronary revascularization were found. Among those at low risk, FFS patients were as likely to undergo angiography as HMO patients but more likely than Medicaid and uninsured patients. For those at high risk, FFS patients were more likely to undergo angiography than patients in other payor groups. Adjusted mean length of stay (7.3 days) was similar among all payor groups, but adjusted mortality was higher in the Medicaid group (Medicaid vs. FFS: OR 1.55, 95% CI 1.19 to 2.01).
  
  
  CONCLUSIONS
  Payor status is associated with the use and appropriateness of invasive cardiac procedures but not length of hospital stay after myocardial infarction. The higher in-hospital mortality in the Medicaid cohort merits further study.
authors.affiliation: Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sada
authors.forename: W J
authors.initials: WJ
authors.lastname: French
authors.forename: D M
authors.initials: DM
authors.lastname: Carlisle
authors.forename: N C
authors.initials: NC
authors.lastname: Chandra
authors.forename: J M
authors.initials: JM
authors.lastname: Gore
authors.forename: W J
authors.initials: WJ
authors.lastname: Rogers
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000191:economics / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000191:economics / Q000706:statistics & numerical data; D016507:Cardiology Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000191:economics / Q000706:statistics & numerical data; D017281:Cost of Illness; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006334:Heart Function Tests / Q000191:economics* / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome; D017664:Uncompensated Care; D014481:United States / Q000453:epidemiology