Top health care linked to ability to pay

September 12, 1990|By Los Angeles Times

High-tech medical treatment goes more often to private-pay patients than to people with public insurance or no insurance, according to a new study that found that how a person pays for his medical care may influence the kind of care he gets.

The finding, to be published today in the Journal of the American Medical Association, may seem self-evident but, in fact, undercuts what many believe is a basic tenet of medicine -- that a person's care is dictated simply by the state of his health.

"The finding is alarming because I think the health care system is assumed to be set up in such a way that medical decisions are made on the basis of ... the clinical characteristics of patients," said Joel Weissman, an instructor in health policy at Harvard Medical School and a co-author of the paper.

"I think most Americans are uncomfortable with a situation where there is evidence that maybe some medical decisions are being made on the basis of ability to pay," he said.

The study, by researchers at Tufts and Harvard universities, examined the care of 38,000 Massachusetts patients hospitalized with circulatory disorders or chest pain.

Most had private insurance; the rest had no insurance or Medicaid, publicly financed insurance for the poor.

The researchers found that the odds that a privately insured patient would receive angiography were 80 percent higher than the odds for an uninsured patient.

Angiography is an expensive procedure used for examining blood vessels for blockages.

The odds that privately insured patients would receive bypass graft surgery were 40 percent higher than they were for the uninsured. They were 28 percent higher in the case of angioplasty, a method of widening narrowed arteries using a catheter and a small balloon.

The odds for Medicaid patients were generally similar to those for the uninsured.

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