Ability to pay found crucial in health-care gap

September 12, 1990|By Boston Globe

New research is documenting how well-insured patients get access to the full panoply of technology while doctors offer uninsured or Medicaid patients strikingly less.

Two reports published in the Journal of the American Medical Association reveal this widening double standard in U.S. medicine for patients with heart disease and acquired immune deficiency syndrome.

A Massachusetts study shows that heart patients with private insurance are much more likely to get a key diagnostic test, undergo bypass surgery or have artery-clearing treatment than similar patients who are uninsured or depend on Medicaid.

New York researchers found a dramatic increase in the proportion of AIDS patients around the nation covered by Medicaid rather than private insurance. This "Medicaidization" of AIDS bodes ill for patients' access to continuous care or expensive new treatments, say that report's authors.

The reports represent a growing body of evidence that the ability of patients to pay makes a crucial difference in the kind of care they get. Health researchers believe well-insured patients may get too much expensive and risky care, while those who lack coverage or depend on Medicaid are denied necessary and even life-saving care.

Later this month, Harvard researchers are expected to release a state-commissioned survey of Massachusetts residents who lack health insurance and how this affects their medical care.

The studies published today "present convincing evidence that availability of payment ... does indeed affect the volume, nature and location of care, at least in cardiovascular care and the treatment of AIDS patients," said Dr. James S. Todd, the American Medical Association's chief of staff.

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