Study: Managed-Care Patients Less Likely To Undergo Surgery at Low-Risk Hospitals.

Patients in New York state who undergo coronary artery bypass graft surgery and are covered by either private managed-care or Medicare managed-care insurance are significantly less likely than patients with fee-for-service insurance to have the surgery done in hospitals with lower mortality rates, according to a study published in The Journal of the American Medical Association.

Compared with patients with private fee-for-service insurance, patients with private managed-care insurance were 23% less likely to receive bypass surgery at a lower-mortality hospital. Medicare managed-care insurance patients were 39% less likely. Medicare fee-for-service patients were slightly less likely.

The study included 58,902 adults who were hospitalized for bypass surgery from 1993 to 1996. Of the cardiac surgical centers studied, 14 were classified as lower-mortality hospitals (average mortality rate, 2.1%), and 17 were classified as higher-mortality hospitals (average mortality rate, 3.2%).

On average, patients undergoing surgery at a lower-mortality hospital lived closer to such a hospital, and patients undergoing surgery at a higher-mortality hospital lived closer to a higher-mortality center.