Market reform in New Jersey and the effect on mortality from acute myocardial infarction.
OBJECTIVE
To determine whether mortality rates for patients with acute myocardial infarction (AMI) changed in New Jersey after implementation of the Health Care Reform Act, which reduced subsidies for hospital care for the uninsured and changed hospital payment to price competition from a rate-setting system based on hospital cost.


METHODS
Patient discharge data from hospitals in New Jersey and New York from 1990 through 1996 and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS).


METHODS
A comparison between states over time of unadjusted and risk-adjusted mortality and cardiac procedure rates.


METHODS
Discharge data were obtained for 286,640 patients with the primary diagnosis of AMI admitted to hospitals in New Jersey or New York from 1990 through 1996. Records of 364,273 NIS patients were used to corroborate time trends.


RESULTS
There were no significant differences in AMI mortality among insured patients in New Jersey relative to New York or the NIS. However, there was a relative increase in mortality of 41 to 57 percent among uninsured New Jersey patients post-reform, and their rates of expensive cardiac procedures decreased concomitantly.


CONCLUSIONS
The introduction of hospital price competition and reductions in subsidies for hospital care of the uninsured were associated with an increased mortality rate among uninsured New Jersey AMI patients. A relative decrease in the use of cardiac procedures in New Jersey may partly explain this finding. Additional studies should be done to identify whether other market reforms have been associated with changes in the quality of care.
Volpp
Kevin G M
KG
Center for Health Equity Research and Promotion, Philadelphia Veterans Hospital, and University of Pennsylvania School of Medicine, 19104-6021, USA.
Williams
Sankey V
SV
Waldfogel
Joel
J
Silber
Jeffrey H
JH
Schwartz
J Sanford
JS
Pauly
Mark V
MV
D000328:Adult; D000368:Aged; D004465:Economic Competition / Q000331:legislation & jurisprudence*; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality* / Q000628:therapy; D009515:New Jersey / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care / Q000639:trends*; D013221:State Health Plans / Q000331:legislation & jurisprudence*; D017664:Uncompensated Care / Q000191:economics; D014481:United States