Underuse of invasive procedures among Medicaid patients with acute myocardial infarction.
OBJECTIVE
The purpose of this study was to determine whether underuse of cardiac procedures among Medicaid patients with acute myocardial infarction is explained by or is independent of fundamental differences in age, race, or sex distribution; income, coexistent illness; or location of care.


METHODS
Administrative data from 226 hospitals in New York were examined for 11,579 individuals hospitalized with a primary diagnosis of acute myocardial infarction. Use of various cardiac procedures was compared among Medicaid patients and patients with other forms of insurance.


RESULTS
Medicaid patients were older, were more frequently African American and female, and had lower median household incomes. They also had a higher prevalence of hypertension, diabetes, lung disease, renal disease, and peripheral vascular disease. After adjustment for these and other factors, Medicaid patients were less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, and any revascularization procedure.


CONCLUSIONS
Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation.
Philbin
E F
EF
Division of Cardiology, Albany Medical College, (Mail Code 44), 47 New Scotland Ave, Albany, NY 12208, USA. philbie@mail.amc.edu
McCullough
P A
PA
DiSalvo
T G
TG
Dec
G W
GW
Jenkins
P L
PL
Weaver
W D
WD
D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000191:economics / Q000706:statistics & numerical data*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D009518:New York / Q000453:epidemiology; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors