In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals

Juliana de Oliveira Costa; Sallie-Anne Pearson; David Brieger; Sanja Lujic; Md Shajedur Rahman Shawon; Louisa R Jorm; Kees van Gool; Michael O Falster

doi:10.1186/s12939-023-02030-1

In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals

Int J Equity Health. 2023 Oct 23;22(1):226. doi: 10.1186/s12939-023-02030-1.

Authors

Juliana de Oliveira Costa^{1

2}, Sallie-Anne Pearson³, David Brieger⁴, Sanja Lujic⁵, Md Shajedur Rahman Shawon⁵, Louisa R Jorm⁵, Kees van Gool⁶, Michael O Falster^{3

5}

Affiliations

¹ Medicines Intelligence Research Program, School of Population Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia. j.costa@unsw.edu.au.
² Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia. j.costa@unsw.edu.au.
³ Medicines Intelligence Research Program, School of Population Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
⁴ Concord Clinical School - The University of Sydney, Sydney, Australia.
⁵ Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
⁶ Centre for Health Economics Research and Evaluation - University of Technology Sydney, Sydney, Australia.

Abstract

Background: International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

Methods: We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017-2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors.

Results: Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45-0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients.

Conclusion: Our findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes.

Keywords: Health insurance; Healthcare disparities; Hospitals; Myocardial infarction; Percutaneous coronary intervention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Cohort Studies
Hospital Mortality
Hospitals, Public
Humans
Insurance, Health
Myocardial Infarction* / surgery
New South Wales / epidemiology
Percutaneous Coronary Intervention* / adverse effects
Treatment Outcome