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 Patients who switch from private to public insurance, like Medicare
or Medicaid, have shorter lifespans than those who stay with private
insurance in the year after the transplant, researchers found. At
the same time, people who had public insurance and switched to
private in the year after surgery improved their survival odds.
“It was surprising that insurance status changes over a short period
of time were indeed associated with heart transplantation outcomes,”
said lead author Dmitry Tumin of The Ohio State University in
Columbus.
“Based on our findings, we suggest that helping people keep their
insurance during the transplant process is a policy option that
merits further study,” Tumin told Reuters Health by email.
The researchers analyzed data from a United Network for Organ
Sharing (UNOS) registry of 11,681 U.S. adults aged 10 to 64 years
old who underwent first-time heart transplants between 2006 and
2013.
Of these patients, about one in five changed insurance coverage type
between being put on the waiting list for a heart and one year
post-transplant. Most patients, 44 percent, had continuous private
insurance and 27 percent had continuous public insurance.
Half of patients survived for four years or less after transplant.
Compared to people who had continuous private insurance coverage,
those on public insurance had 36 percent higher risk of dying during
the follow-up period. Those who transitioned from private to public
insurance in the first year after transplant had 25 percent higher
risk of death.
People who switched from public to private insurance, however, had a
22 percent lower risk of death than those who were continuously
covered by public insurance, according to the results in published
September 13 in Circulation: Cardiovascular Quality and Outcomes.
Among people who transitioned to private insurance, only 12 percent
died during the study follow-up, compared to 17 percent of those who
had continuous public insurance.
The differences in survival remained after researchers adjusted for
other factors that might influence transplant survival, including
social and economic factors, race, age and other health conditions.
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“U.S. transplant centers generally require patients to have some
form of insurance before they are waitlisted for a transplant,”
Tumin said. “Recent studies suggest that transplant recipients with
private insurance have better access to care, better adherence to
treatment and are favorably selected for characteristics that
predict improved survival.”
In general, private insurance is associated with better surgical
outcomes for a number of procedures, he said.
Insurance coverage identifies different populations, with people on
public insurance tending to be younger, to have disabilities, and to
be of lower socioeconomic status than others, said Dr. Francis D.
Pagani of the University of Michigan in Ann Arbor, who wrote a
commentary accompanying the results.
Public insurance coverage may be lesser than private and make it
harder to keep buying and taking medications to help your body
accept the organ, Pagani told Reuters Health. Also, a switch to
public insurance could indicate other changes in a patient’s life –
maybe she could not go back to work, was less financially stable and
had to go on Medicare, he said.
Social workers on transplant teams should help make sure patients
can afford their medications, can get to clinic appointments and
have necessary transportation, especially when insurance status
changes, Pagani said.
SOURCE: http://bit.ly/2cFkwED and http://bit.ly/2cnqFXN
Circ Cardiovasc Qual Outcomes 2016.
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