Federal and state cost share compared to private health insurance: a 2022 nationwide analysis of outcomes in patients with acute-on-chronic heart failure
R Aller Rojas, C ShiAbstract
Background
An estimated more than 6 million adults in the United States live with heart failure (HF), which is projected to affect another 2 million by 2030. Additionally, studies suggest the number of annual hospitalizations for HF have significantly increased over recent years alongside growing direct medical costs for HF treatment, projected to reach more than $50 billion within the next 5 years.
Purpose
We sought to compare in-hospital mortality and other outcomes among patients diagnosed with acute-on-chronic heart failure (ACHF) in the 2022 NIS, stratified by insurance type.
Methods
Heart failure patients in the 2022 NIS were categorized based on acuity. ACHF patients were selected using appropriate ICD-10 codes. Primary outcome was in-hospital mortality and secondary outcomes included: length of stay (LOS), total hospitalization charges (TOTCHG) and need for left ventricular assist device (LVAD). Multivariate linear and logistic regression were performed using STATA 19.5.
Results
Among 65,900 adult patients with diagnosed ACHF, primary insurance status included Medicare (60%), Medicaid (20%), private insurance (16%), and no insurance (4%). ACHF patients with Medicaid had lower odds of mortality versus those with private insurance (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI]: 0.43−0.84 p < 0.001), although statistically insignificant after adjusting for confounders (aOR: 0.76, 95% CI: 0.52−1.11; p = 0.16). Additionally, ACHF patients with Medicaid had significantly lower odds of LVAD utilization (aOR: 0.42, 95% CI: 0.22−0.79; p < 0.001), significantly lower mean TOTCHG (-$36,001, 95% CI: -$69,061 to -$2,941; p = 0.03) and marginally decreased mean LOS versus the privately insured (-0.89 days, 95% CI: -1.68 to -0.11; p = 0.02) irrespective of hospital and patient level characteristics.
Conclusion
ACHF patients with primary Medicaid insurance had significantly lower TOTCHG and LOS as well as lower odds of undergoing LVAD placement compared to patients with private insurance. There were no statistically significant differences in mortality between the two groups.