Tuesday, August 03, 2010

Chart of the Day

A new study from several University of Virginia doctors compares mortality among surgical patients on Medicare, Medicaid, private insurance and the uninsured. The study examined nearly 900,000 operations over five years derived from the Nationwide Inpatient Sample. The authors adjusted the data to control for "30 co-morbid conditions, along with age, gender, income, geographic region, and surgical procedure."

Critical Condition's Avik Roy explains the study's findings:
They then examined three measurements of surgical outcome quality: the rate of in-hospital mortality; average length of stay in the hospital (longer stays in the hospital are a marker of poorer outcomes); and total costs.

source: Critical Condition via American Surgical Association

The in-hospital death rate for surgical patients with private insurance was 1.3%. Medicare, uninsured, and Medicaid patients were 54%, 74%, and 97% more likely to die than those with private insurance.

The average length of stay in the hospital was 7.38 days for those with private insurance; on an adjusted basis, those with Medicare stayed 19% longer; the uninsured stayed 5% shorter; and those with Medicaid stayed 42% longer.

Total costs per patient were $63,057 for private insurance; Medicare patients cost 10% more; uninsured patients 4% more; and Medicaid patients 26% more.

In summary: Medicaid patients were almost twice as likely to die as those with private insurance; their hospital stays were 42% longer, and cost 26% more. Compared to those without health insurance, Medicaid patients were 13% more likely to die, stayed in the hospital for 50% longer, and cost 20% more.
Roy cites four other studies showing similar underperformance for Medicaid and/or Medicare patients.

I'm unsurprised. But it's probably too late to do much about it until Republicans control Congress.


A_Nonny_Mouse said...

But, of course, Medicaid patients are by definition poor; is it possible that there's something associated with poverty --maybe they wait longer before seeking medical attention; maybe they don't eat as well, or have chronic "unhealthy lifestyle" issues which leave their health or immunity compromised before they're admitted for treatment-- and that's why their outcomes are not as good?

MaxedOutMama said...

Medicaid patients often have multiple illnesses.

Also, a lot of poor older people also are on Medicaid. Obviously Medicare patients are much older than the general population and so have more risks.

Among the classes of younger individuals most likely to be on Medicaid are HIV patients and disabled persons plus a good portion of the chronically mentally ill. The "uninsured" persons are mostly younger, poorer but working, so they are considerably more likely to be healthy.

Insurance is not the only factor in health outcomes by a long shot. The same doctors operate on all these people, the same nurses take care of them, and the same techs and labs do the testing.

I think it is true that Medicaid and, to some extent, Medicare patients see a bit less of their doctors. However Medicaid patients have trouble finding a good primary doctor anyway, and multiple medical problems tend to snowball without excellent primary care.

Anyway, being in the hospital for very long is a medical risk factor in and of itself. And being in a hospital that has a high number of lower-paying patients (those on government insurance) usually means that the nurses are covering far more patients than is really possible. It is the nursing care and general cleanliness in most hospitals that produces better outcomes.

Carl said...

I haven't yet read the study--only the abstract has been published to date. But based on that, and on Roy's analysis, the authors controlled for "sickness," poverty--by comparing only like with like. Read Roy's articles about the study, linked to in my piece; he addresses those concerns.