Managed care and outcomes of hospitalization among elderly patients with congestive heart failure.

Abstract

CONGESTIVE heart failure (CHF) has remained the leading cause of hospitalization among people aged 65 years or older,^1-3 and consequently has imposed a large financial burden on patients, their families, and health care systems. To improve the quality of care for heart failure while containing the cost of care, it is important to understand factors associated with accessibility of care and short-term outcomes of CHF in hospital settings. Previous studies^4,5 have reported that patients with different types of health insurance but similar medical problems may receive different treatment strategies and intensity of treatment, which may result in differences in short-term and long-term outcomes. Specifically, concerns have been raised regarding the quality of medical care received by managed care patients.^6-9 Although a number of studies^10,11 have suggested that managed care patients experienced shorter hospital stays, whether managed care patients received substandard care that resulted in poorer outcomes has remained controversial. Additionally, to our knowledge no prior study has examined the impact of the health maintenance organization (HMO)–managed care on patients hospitalized for CHF. Understanding this issue is important with regards to the increasing prevalence of CHF among the elderly population as well as the growing enrollment of Medicare beneficiaries in managed care.^12-14