The Impact of Fee-for-Service and Managed Care Insurance on Access to Cardiac Care in Maryland

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Cardiovascular disease is one of the leading causes of death in the United States. The treatment of acute myocardial infarction (AMI) provides a useful model for studying the impact of fee-for-service and HMO insurance on access to cardiac care. Prior studies provide evidence in support of a disparity in access to cardiac care by insurance type, but no other study has examined the impact of insurance type in a regulated hospital industry. This study is unique because it explores the impact of a regulatory approach that is supplemented by the workings of a competitive market on access to cardiac care for AMI patients. After controlling for age, sex, and race, it was observed that HMO AMI patients were less likely to receive cardiac catheterizations (OR = 0.827 at the 95 percent confidence level) and CABG surgery (OR = 0.852 at 95 percent confidence level) when compared to FFS AMI patients. HMO AMI patients were slightly more likely to receive a PTCA cardiac procedure (OR = 1.067 at the 95 percent confidence level) than FFS AMI patients.

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