• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of hsresearchLink to Publisher's site
Health Serv Res. Aug 1998; 33(3 Pt 1): 447–466.
PMCID: PMC1070271

Insurance type and choice of hospital for coronary artery bypass graft surgery.

Abstract

OBJECTIVE: To examine the effect of insurance type on the relationship between hospital attributes and patient flows, with particular attention to whether HMO enrollees are more or less likely than other patients to receive care at high-quality hospitals and whether HMO enrollees travel farther to receive care. DATA SOURCES/STUDY SETTING: Data on patient flows, taken from discharge abstracts compiled by the California Office of Statewide Health Planning and Development. Our sample consists of patients undergoing coronary artery bypass graft surgery (CABG) in 1991 who resided in three California markets. Only patients under the age of 65 and insured by HMOs, Blue Cross/Blue Shield, or other commercial insurance were included. Hospital quality is based on hospital-specific measures of excess mortality from CABG. Other hospital attributes were taken from American Hospital Association survey data. STUDY DESIGN: Conditional-choice models were used to estimate the probability that patients would receive care at any given hospital as a function of their insurance type and the hospital's attributes. PRINCIPAL FINDINGS: Patients were more likely to receive care from hospitals closer to their residence. However, HMO patient flows were less sensitive to proximity. In general, the likelihood that an HMO enrollee received care at a given hospital was positively related to hospital quality. Moreover, quality had a greater effect on patient flows for HMO enrollees than for non-HMO enrollees. However, the evidence suggests that the effect of quality on patient flows is neither uniform across markets nor across HMOs. CONCLUSIONS: HMOs do not appear to direct patients to low-quality hospitals. However, heterogeneity among HMOs and across markets suggests that buyers must recognize that choosing an HMO involves greater scrutiny than simply picking a plan labeled "HMO."

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.9M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Adams EK, Houchens R, Wright GE, Robbins J. Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness. Health Serv Res. 1991 Dec;26(5):583–612. [PMC free article] [PubMed]
  • Adler GS. Medicare beneficiaries rate their medical care: new data from the MCBS (Medicare Current Beneficiary Survey). Health Care Financ Rev. 1995 Summer;16(4):175–187. [PubMed]
  • Blendon RJ, Knox RA, Brodie M, Benson JM, Chervinsky G. Americans compare managed care, Medicare, and fee-for-service. J Am Health Policy. 1994 May-Jun;4(3):42–47. [PubMed]
  • Blustein J, Weitzman BC. Access to hospitals with high-technology cardiac services: how is race important? Am J Public Health. 1995 Mar;85(3):345–351. [PMC free article] [PubMed]
  • Burns LR, Wholey DR. The impact of physician characteristics in conditional choice models for hospital care. J Health Econ. 1992 May;11(1):43–62. [PubMed]
  • Carlisle DM, Siu AL, Keeler EB, McGlynn EA, Kahn KL, Rubenstein LV, Brook RH. HMO vs fee-for-service care of older persons with acute myocardial infarction. Am J Public Health. 1992 Dec;82(12):1626–1630. [PMC free article] [PubMed]
  • Chewnew M. HMO use of diagnostic tests: a review of the evidence. Med Care Res Rev. 1995 Jun;52(2):196–222. [PubMed]
  • Chernew M, Hayward R, Scanlon D. Managed care and open-heart surgery facilities in California. Health Aff (Millwood) 1996 Spring;15(1):191–201. [PubMed]
  • Dubois RW, Rogers WH, Moxley JH, 3rd, Draper D, Brook RH. Hospital inpatient mortality. Is it a predictor of quality? N Engl J Med. 1987 Dec 24;317(26):1674–1680. [PubMed]
  • Feldman R, Chan HC, Kralewski J, Dowd B, Shapiro J. Effects of HMOs on the creation of competitive markets for hospital services. J Health Econ. 1990 Sep;9(2):207–222. [PubMed]
  • Garnick DW, Lichtenberg E, Phibbs CS, Luft HS, Peltzman DJ, McPhee SJ. The sensitivity of conditional choice models for hospital care to estimation technique. J Health Econ. 1989;8(4):377–397. [PubMed]
  • Hannan EL, Kilburn H, Jr, O'Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates. JAMA. 1990 Dec 5;264(21):2768–2774. [PubMed]
  • Hannan EL, Kilburn H, Jr, Lindsey ML, Lewis R. Clinical versus administrative data bases for CABG surgery. Does it matter? Med Care. 1992 Oct;30(10):892–907. [PubMed]
  • Hartz AJ, Gottlieb MS, Kuhn EM, Rimm AA. The relationship between adjusted hospital mortality and the results of peer review. Health Serv Res. 1993 Feb;27(6):765–777. [PMC free article] [PubMed]
  • Hofer TP, Hayward RA. Identifying poor-quality hospitals. Can hospital mortality rates detect quality problems for medical diagnoses? Med Care. 1996 Aug;34(8):737–753. [PubMed]
  • Iezzoni LI, Foley SM, Daley J, Hughes J, Fisher ES, Heeren T. Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA. 1992 Apr 22;267(16):2197–2203. [PubMed]
  • Keeler EB, Rubenstein LV, Kahn KL, Draper D, Harrison ER, McGinty MJ, Rogers WH, Brook RH. Hospital characteristics and quality of care. JAMA. 1992 Oct 7;268(13):1709–1714. [PubMed]
  • Krakauer H, Bailey RC, Skellan KJ, Stewart JD, Hartz AJ, Kuhn EM, Rimm AA. Evaluation of the HCFA model for the analysis of mortality following hospitalization. Health Serv Res. 1992 Aug;27(3):317–335. [PMC free article] [PubMed]
  • Landon B, Iezzoni LI, Ash AS, Shwartz M, Daley J, Hughes JS, Mackiernan YD. Judging hospitals by severity-adjusted mortality rates: the case of CABG surgery. Inquiry. 1996 Summer;33(2):155–166. [PubMed]
  • Luft HS, Garnick DW, Mark DH, Peltzman DJ, Phibbs CS, Lichtenberg E, McPhee SJ. Does quality influence choice of hospital? JAMA. 1990 Jun 6;263(21):2899–2906. [PubMed]
  • Luft HS, Romano PS. Chance, continuity, and change in hospital mortality rates. Coronary artery bypass graft patients in California hospitals, 1983 to 1989. JAMA. 1993 Jul 21;270(3):331–337. [PubMed]
  • McGuirk MA, Porell FW. Spatial patterns of hospital utilization: the impact of distance and time. Inquiry. 1984 Spring;21(1):84–95. [PubMed]
  • O'Rourke LM. Do quality report cards make a difference? The New York and Pennsylvania experience with releasing physician-specific outcomes. Qual Lett Healthc Lead. 1993 Jul-Aug;5(6):2–11. [PubMed]
  • Park RE, Brook RH, Kosecoff J, Keesey J, Rubenstein L, Keeler E, Kahn KL, Rogers WH, Chassin MR. Explaining variations in hospital death rates. Randomness, severity of illness, quality of care. JAMA. 1990 Jul 25;264(4):484–490. [PubMed]
  • Retchin SM, Brown B. Management of colorectal cancer in Medicare health maintenance organizations. J Gen Intern Med. 1990 Mar-Apr;5(2):110–114. [PubMed]
  • Romano PS. Can administrative data be used to compare the quality of health care? Med Care Rev. 1993 Winter;50(4):451–477. [PubMed]
  • Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware JE., Jr Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. JAMA. 1993 Aug 18;270(7):835–840. [PubMed]
  • Sloss EM, Keeler EB, Brook RH, Operskalski BH, Goldberg GA, Newhouse JP. Effect of a health maintenance organization on physiologic health. Results from a randomized trial. Ann Intern Med. 1987 Jan;106(1):130–138. [PubMed]
  • Thomas JW, Holloway JJ, Guire KE. Validating risk-adjusted mortality as an indicator for quality of care. Inquiry. 1993 Spring;30(1):6–22. [PubMed]
  • Ware JE, Jr, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA. 1996 Oct 2;276(13):1039–1047. [PubMed]
  • Welch WP, Hillman AL, Pauly MV. Toward new typologies for HMOs. Milbank Q. 1990;68(2):221–243. [PubMed]
  • Wyszewianski L. Quality of care: past achievements and future challenges. Inquiry. 1988 Spring;25(1):13–22. [PubMed]
  • Yelin EH, Criswell LA, Feigenbaum PG. Health care utilization and outcomes among persons with rheumatoid arthritis in fee-for-service and prepaid group practice settings. JAMA. 1996 Oct 2;276(13):1048–1053. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...