title: Potentially avoidable rehospitalizations following acute myocardial infarction by insurance status.
abstract: Few studies have explored the impact of health insurance on patients with severe, chronic diseases. This retrospective study examined the association between health insurance and the risk of potentially avoidable rehospitalization in the 3 years following validated acute myocardial infarction (AMI) for a community-based probability sample of 683 patients admitted to 30 California hospitals in 1990-1991. In a multivariate analysis adjusted for measures of comorbidity burden, severity of illness, and AMI-related inpatient care, the risk of readmission was not significantly different among patients with no insurance, Medicare insurance, and non-Medicaid, non-Medicare ("private or other") insurance. However, compared to the latter group, patients with Medicaid were 2.6 times more likely to be readmitted for an AMI-related process (risk ratio. 2.61; 95% confidence interval, 1.33 to 5.11). Additional studies are needed to define the role of health insurance on clinical outcomes and health care access across a broader range of conditions and communities.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of California Davis Medical Center, Sacramento 95817-1498, USA. jzgarcia@ucdavis.edu
authors.forename: Jorge A
authors.initials: JA
authors.lastname: García
authors.forename: Martin C
authors.initials: MC
authors.lastname: Yee
authors.forename: Benjamin K S
authors.initials: BK
authors.lastname: Chan
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
mesh_terms: D000208:Acute Disease; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D002140:California / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000145:classification* / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index