nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Sunday, July 18, 2010

Medicaid Patients Have Higher Surgical Mortality Than The Uninsured?

I'm not sure what to make of this study yet.

A paper was presented at the annual meeting of the American Surgical Association in April of this year that looked at surgical mortality by insurance coverage.  It hasn't been published yet that I'm aware of.

In other words, how many people died after operations based on what type of health coverage they had?  The options were Medicare, Medicaid, uninsured, private insurance.

It was a big study (893,000 cases), some 40K were Medicaid.  It was a common database (the Nationwide Inpatient Sample).  And there were significant differences.

You might expect that the uninsured would do worse.  That's why we did HCR, right?  To cover the uninsured, who were suffering from lack of access to care and prevention?

The study adjusted for age, gender, economic status, geography, and other co-existent diseases...all the common things you eliminate. 

Actually, Medicaid did the worst.  Here's the data provided in the abstract:

Outcome     Medicaid              Uninsured            Medicare              Private Ins
In-Hospital  1.97 (1.84-2.10)    1.74 (1.60-1.90)    1.54 (1.48-1.61)    Ref (i.e., 1.0)

[* p<0.001.  The numbers are odds ratios, with confidence intervals in parenthesis.]

The table says that if you are on Medicaid your odds of dying are 1.97 times that of private insurance.

BUT, it also says your odds of dying are higher than NO insurance:  1.97 versus 1.74.  That is unexpected.

Bloggers on the Right and Left will try to explain the data in the interest of their own ideology, but I'm not convinced that this is telling us something useful yet.  I want to see the article.

There could be differences that point to Medicaid being a poor setup to get people good medical care, or it could say that Medicaid patients don't get preventive care that others do:  either because they are not prone to, or because it's not as easy for them to obtain it.   But you would think the uninsured would have an even worse problem in these areas.  So, Is it behavior or systemic?  The data doesn't tell us either way. 

I recommend we forget the bloggers (except me, of course) and wait for more info.

Doc D


WarmSocks said...

Or maybe the uninsured don't have the money to go to a doctor, so they die without surgical treatment and are entirely omitted from the data.

Doc D said...

Good point.

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