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Health Care Costs and Financing

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Costs are about the same for generalists and specialists who treat patients with chronic heart problems

Expenditures for elderly Medicare patients with coronary artery disease (CAD) are higher when their principal care doctor is a cardiologist rather than a generalist. However, this is only when the cardiologist treats patients who have serious and costly heart problems, such as myocardial infarction (heart attack) or unstable angina. Costs are about the same for cardiologists and generalists who are treating patients with chronic heart problems. Also, the presence of coexisting illnesses doesn't seem to influence expenditures. These are the findings of a study by researchers at the Johns Hopkins University, the Indian Health Service at Chinle, AZ, and the Agency for Healthcare Research and Quality.

The researchers examined the physician type (cardiologist or generalist) and expenditures for over 250,000 elderly patients with CAD drawn from a 5 percent national sample of 1992 Medicare beneficiaries. Patients in the cardiologist group had lower numbers of coexisting illnesses (comorbidity) and higher severity of CAD than those in the generalist group.

Overall mean expenditures were significantly higher for the cardiologist group than for the generalist group ($7,658 vs. $6,047), and these differences were evident at all levels of comorbidity. Patients with acute myocardial infarction or unstable angina seen by cardiologists incurred more expenses than those seen by generalists (mean of $15,378 vs. $12,260), probably because cardiologists tend to treat these patients more aggressively. However, the mean expenditures for patients with only chronic CAD conditions were similar ($4,856 vs. $4,745).

Allowing patients with CAD, whether acute or chronic, to choose a cardiologist as their principal care provider may cost managed care organizations little, if anything, extra and may increase patient satisfaction, conclude the researchers. They suggest that patients and payers consider coexisting illnesses and severity of CAD when evaluating the potential trade-offs between additional costs and benefits that may derive from specialty care.

More details are in "Specialty of principal care physician and Medicare expenditures in patients with coronary artery disease: Impact of comorbidity and severity," by Robert L. McNamara, M.D., M.H.S., Neil R. Powe, M.D., M.P.H., M.B.A., David R. Thiemann, M.D., and others, in the March 2001 American Journal of Managed Care 7(3), pp. 261-266.

Reprints (AHRQ Publication No. 01-R058) are available from the AHRQ Publications Clearinghouse.

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