Quality of Care Varies by Insurance Type Even within the Same Hospital

medicaid-spendingWe found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. (Health Affairs)

Comments (10)

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  1. Adam says:

    Ok, granted, but what can we conclude from this? It’s likely, if not certain, that the factors which drive people to Medicare are also risk-factors for increased mortality.

    • Jackson says:

      Yeah, it’s hard to agree on the conclusion of the paper, as it doesn’t seem to account for those external factors.

      In their minds it seems to just be: medicare receives worse quality, therefore there is something intrinsically wrong with either medicare or the way doctors treat it, not the patient.

  2. Billy says:

    See, the government doesn’t do it better.

  3. Bobby says:

    Interesting. Thanks Dr. Goodman.

  4. BHS says:

    “Medicare patients appeared particularly vulnerable to receiving inferior care.”

    And yet people want more government involvement in our health care.

  5. Dr. Mike says:

    Care is inferior only if your “risk adjustment” is perfect. As Medicare enrollees are for the most part 65 years old and older, and private insurance enrolees are for the most part younger than age 65, it seems possible that the risk adjustment was not perfect when comparing the two groups. If there really is inferiority of care for the Medicare group it seems just as likely to me that it represents age bias, with the undoubtedly young hospital staff consciously or unconsciously investing more effort into the care of younger patients with presumably greater chance of post hospital quality of life. I very much doubt it has anything at all to do with payer source as there is no incentive for the staff to differentiate when they get paid the same no matter the payer source.