Lars C. Erickson, M.D., M.P.H., from Children's Hospital Boston, and colleagues, conducted a study of 58,902 patients hospitalized for CABG surgery from 1993 to 1996 using New York Department of Health databases to determine the use of lower-mortality hospitals by patients with different types of health insurance. Instead, there was a statistically significant tendency for managed care plans to use centers with higher mortality rates, even after researchers adjusted the results for factors that may have confounded the results.
Financial risk provides a strong incentive for health plans to select low-priced hospitals.
They explain that California has numerous low-volume hospitals with high mortality rates performing CABG surgery. They say because low volumes make contracting unattractive, managed care plans in California avoid sending their patients to the highest mortality hospitals. The authors Erickson et. This could inadvertently stifle incentives for hospitals to compete on the quality of care. Additional studies on the impact of quality information on health plans' contracting decisions will be important as price competition among health plans becomes more intense.