A new study published in Health Affairs finds that medical patients with private insurance typically enjoy a higher quality of care than Medicare beneficiaries, even when controlling for factors such as varying risk profiles from patient-to-patient.
We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality’s innovative Inpatient Quality Indicators and pooled 2006–08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care.
There have got to be a number of reasons for this, and it’s probably not fair to assume that this can really be taken as a totally accurate, “head-to-head” comparison of Medicare and private insurance. (For one thing, many physicians do not accept Medicare beneficiaries. Although the study relies on in-hospital comparisons, it’s still possible that those patients who rely on Medicare for access to their medical care are being treated by a different ‘type’ of physician than those with private insurance–I am NOT drawing judgments about the quality of doctors who see Medicare patients and the quality of those who do not, I’m just trying to be fair and point out a potentially confounding variable). Unfortunately, I do not have access to the journal article at the moment, so I will have to look at the study in closer detail at some point in the next few days to see how they discuss any discrepancies that might arise from the design of the study itself rather than underlying provider disparities.
It will be interesting to see how the conversation around this study unfolds. For what it’s worth, the Cato Institute’s Michael Cannon has been involved in a couple of disagreements over the relative efficiencies and inefficiencies of private insurance and Medicare before, so if you’re interested you can do some more reading on those here and John Goodman of the National Center for Policy Analysis also uses a lot of statistical evidence to show why he doesn’t buy claims that Medicare has lower costs than private insurance here. It’s also worth noting that “Cannon’s First Rule of Economic Literacy” –never say costs when what you mean is spending –can come in pretty handy during these sorts of conversations.
For a different perspective, check out Austin Frakt’s response to the Goodman article here.