HMO members twice as likely to die of heart attacks Outcome tied to policies that discourage ER visits


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, the cardiologist who did the research at the Lancaster Heart Foundation in Pennsylvania. "Traditionally, we always looked at patient risk factors."

The study of 4,000 heart attack patients found 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's unfortunate that a care-giving organization would contribute to patients' natural tendency to delay treatment. The study points up the need for HMOs to study whether their policies are safe for patients, he said.

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.

Pub Date: 11/13/97

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