Study shows HMO emergency care for acute myocardial infarction equal to or better than with fee-for-service insurance
BOSTON, MA - The timeliness and quality of care for elderly patients with acute myocardial infarction (AMI) who are covered by non-profit health maintenance organizations (HMO) is equal to, or better than, the care provided under fee-for-service insurance, according to a study in the September 27, 1999 edition of the Archives of Internal Medicine. Two indicators of clinical quality - use of lifesaving therapy and use of emergency transportation - were higher among elderly patients enrolled in HMOs than in fee-for-service. In all other areas studied, the clinical data between HMO and fee-for-service coverage were comparable.
Cardiovascular disease is the leading cause of disability and death in the elderly, and, each year, nearly 300,000 Americans die of a heart attack before reaching the hospital. Of those who survive, most of the permanent damage done to the heart occurs during the first hour following a heart attack.
Despite public fears that managed care may interfere with the provision of timely urgent care, especially among vulnerable patients like the elderly, the study's findings indicate otherwise. One example was the higher use of emergency transportation by HMO patients (56%) compared to patients with fee-for-service coverage (51%). Most of the ambulance use by HMO patients occurred at night, suggesting that 24-hour call-in lines or other services available from HMOs may have improved patients' access to emergency transportation. The study also found that HMO patients were somewhat more likely than fee-for-service patients to receive aspirin (88% vs. 83%) and beta-blocker therapies (73% vs. 62%) en route to or soon after arrival at the hospital.
For this study, Stephen B. Soumerai, Sc.D., and other researchers at the Department of Ambulatory Care and Prevention, a joint department of Harvard Medical School and Harvard Pilgrim Health Care, reviewed the medical records of 2304 elderly patients admitted with AMI at 20 urban community hospitals in Minnesota. The main outcome measures were, use of emergency transportation and treatment delay; time to electrocardiogram; use of aspirin, thrombolytics, and beta-blockers among eligible patients; and time from hospital arrival to thrombolytic administration.
"While further research is needed to examine different populations and medical conditions, our findings suggest that HMOs in this study provide elderly, heart attack patients with equal or better emergency care than under fee-for-service insurance," said Soumerai.
This study was funded in part by the National Institute on Aging, the Agency for Health Care Policy and Research, and the Harvard Pilgrim Health Care Foundation.
Journal
Archives of Internal Medicine