Medicaid expansion in terms of its eligibility and federal funding has led to improved
healthcare access in previously uninsured individuals. However, proposed lower Medicaid
rates have unintentionally led to lower utilization of substantial life-saving therapies
and poor outcomes compared with private insurance. We examined heart failure (HF)
management, in-hospital mortality, and resource utilization in Medicaid and privately
insured individuals hospitalized with HF. The authors screened the National Inpatient
Sample from January 2012 to September 2015 for HF hospitalizations with Medicaid or
private insurance as the primary payer. The authors identified a total of 226,265
and 292,070 patients with HF hospitalizations with Medicaid and private insurance,
respectively. In propensity-matched cohort of 155,790 hospitalizations in each group,
Medicaid beneficiaries with HF hospitalization had lower rates of intra-aortic balloon
pump/left ventricular assist device/extracorporeal membrane oxygenation utilization
(0.6 vs 0.9%; odds ratio [OR] 0.64; 95% confidence interval [CI] 0.59 to 0.69), heart
transplantation (0.15 vs 0.44%; OR 0.35; 95% CI 0.30 to 0.40), implantable cardioverter-defibrillator/cardiac
resynchronization therapy/permanent pacemaker (3.3 vs 3.9%; OR 0.84; 95% CI 0.81 to
0.87), and had higher rates of in-hospital mortality (1.9 vs 1.7%; OR 1.12; 95% CI
1.07 to 1.19) compared with privately insured individuals (p <0.001 for both). In
conclusion, Medicaid recipients with HF hospitalizations had a lower rate of device
utilization, heart transplantation, and a higher rate of in-hospital mortality compared
with the privately insured sector. Further studies are needed to explore and understand
the variation in the outcomes of HF hospitalizations stratified by insurance status.
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Article info
Publication history
Received in revised form:
December 15,
2019
Received:
November 27,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
