title: The relation between managed care market share and the treatment of elderly fee-for-service patients with myocardial infarction.
abstract: OBJECTIVE
  To determine if greater managed care market share is associated with greater use of recommended therapies for fee-for-service patients with acute myocardial infarction.
  
  
  METHODS
  We examined the care of 112,900 fee-for-service Medicare beneficiaries aged > or = 65 years who resided in one of 320 metropolitan statistical areas and who were admitted with an acute myocardial infarction between February 1994 through July 1995. Use of recommended medical treatments and 30-day survival were determined for areas with low (<10%), medium (10% to 30%), and high (>30%) managed care market share.
  
  
  RESULTS
  After adjustment for severity of illness, teaching status of the admission hospital, and area characteristics, areas with high levels of managed care had greater use of beta-blockers (relative risk [RR] for greater use = 1.18; 95% confidence interval [CI]: 1.06 to 1.29) and aspirin at discharge (RR = 1.05; 95% CI: 1.02 to 1.07), but less appropriate coronary angiography (RR = 0.93; 95% CI: 0.86 to 1.01) and reperfusion (RR = 0.95; 95% CI: 0.85 to 1.03) when compared with areas with low levels of managed care.
  
  
  CONCLUSIONS
  Medicare beneficiaries with fee-for-service insurance who resided in areas with high managed care activity were more likely to have received appropriate treatment with beta-blockers and aspirin, and less likely to have undergone coronary angiography following admission for myocardial infarction. Thus, the effects of managed care may not be limited to managed care enrollees.
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Mark
authors.initials: M
authors.lastname: McClellan
authors.forename: Craig
authors.initials: C
authors.lastname: Frances
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Baker
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D010351:Patient Discharge; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal