HMO members twice as likely to die of heart attack, study says

Policies that discourage ER visits may play a role


ORLANDO, Fla. -- Patients enrolled in health maintenance organizations were twice as likely to die of heart attacks as those in traditional health insurance plans, according to research presented at a meeting of the American Heart Association yesterday.

"We had never looked at insurance as a predictor of patient outcome before," said Dr. Paul Casale, a cardiologist who conducted the research at Lancaster Heart Foundation in Pennsylvania. "Traditionally, we always looked at patient risk factors."

The study of 4,000 heart attack patients found that members of HMOs were less likely than those treated under traditional insurance plans to receive two surgical procedures common after heart attacks.

Casale said that could have contributed to the higher rate of deaths. But he noted that research has been mixed on the benefits of the two procedures, heart catheterization and angioplasty.

In the study, 79 percent of fee-for-service patients received heart catheterization, compared with 70 percent of HMO members. Similarly, 33 percent received angioplasty, vs. 27 percent in HMOs.

Scientists did not have information about how long patients in the study waited to get care. Immediate care is one of the best predictors of good heart attack survival rates.

Casale said he suspected HMO policies discouraged use of emergency rooms and could have played a role. He said it is unfortunate that a caregiving organization would contribute to patients' natural tendency to delay treatment.

"Patients give themselves their own roadblocks in terms of whether they should get emergency care," he said. "If somebody has chest pain, they think, 'Oh, it must just be indigestion.' "

The study points up the need for HMOs to study whether their policies are safe for patients, he said.

"HMOs create policies, but then it's their responsibility to see whether these policies affect patient outcome," Casale said. "And they don't do that."

HMOs emphasize maintenance, providing incentives for patients to receive preventive care, such as prenatal visits and immunizations. Preventive care is supposed to save money by heading off serious problems that are expensive to treat.

Researchers used information from a statewide review of all heart attack patients admitted to Pennsylvania hospitals in 1993. Casale said they focused only on patients in southeastern Pennsylvania, because HMO membership was high in the Philadelphia area then. The study patients were all under age 65, and about one-quarter of them belonged to HMOs.

Pub Date: 11/13/97

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