WASHINGTON — As California has reduced Medicaid payments for expensive heart surgeries, the likelihood that indigent patients will receive the surgeries has also dropped, even though the Medicaid patients are typically sicker than those with fee-for-service or Health Maintenance Organization insurance, researchers report today.
The team studied 140,000 patients who were treated in all non-federal hospitals in California in 1983, 1985 and 1988.
"We found that with greater emphasis on cost-containment, decisions about whether or not to provide certain types of care became more and more strongly associated with a patient's insurance status," said public policy specialist Ken Langa of the University of Chicago Medical Center, co-author of the study.
The findings could have major implications for President Clinton's health care reform plan, particularly his suggestion that $112 billion can be trimmed from Medicaid budgets over five years, said co-author Dr. Elliott J. Sussman of the Lehigh Valley Hospital in Allentown, Pa., formerly of the University of Chicago.
Dr. Sussman said the cost savings are unlikely because more money will be required to bring the level of care of Medicaid patients up to that of privately insured patients. "We are already tremendously under-providing care," Dr. Sussman said, "and the notion of cutting back . . . may be impossible."
The findings "do not surprise me in the least bit, but I would not necessarily attribute the lower rates to the fact that hospitals are getting paid less. That has a sinister implication and I am not sure it is that simple," said Dr. Frank Litvack, co-director of the cardiovascular intervention service at Cedars-Sinai Medical Center in Los Angeles.
Other potential reasons, Dr. Litvack suggested, may be that Medicaid patients are selectively admitted to hospitals that don't perform the procedures, that the patients may not be as willing to undergo surgery or that they are not receiving adequate long-term care and are thus not in good enough health to undergo the procedures.