JAMA Study Shows Profitable Complications Are More Likely in Patients with Good Insurance Coverage


Although most of us would like to believe that all hospital patients receive equal medical treatment regardless of the types of insurance they have, that may not be the case. A new study suggests that patients with “better” insurance plans are more likely to have post-surgical complications – and be scheduled for follow-up appointments – than patients who can’t pay.

A new study published in The Journal of the American Medical Association (JAMA) demonstrates a relationship between major surgical complications and hospital revenues based on a patient’s ability to pay. Surgical complications were more common for patients with good medical coverage resulting in more profits for the hospitals. This means that hospitals do not have incentive to reduce complications in patients with good coverage.

Researchers–including Dr. Atul A. Gawande, a Harvard surgeon and author of books about improving health care– reviewed data on nine common surgical procedures and ten major complications from those procedures. They compared complication rates across four different payment types – private insurance, self-payment, Medicare, and Medicaid. After reviewing data on over 34,000 surgical discharges, the researchers found that 1,820 of those patients (about 5%) experienced one or more post-surgical complications.

At first glance, those numbers don’t appear to be remarkable; however, breaking the complications down by payer type shows a troubling pattern:

  • Medicare: 45%
  • Private insurance: 40%
  • Self-payment: 6%
  • Medicaid: 4%

According to the New York Times, the researchers found that many hospitals profit when they make errors because insurers reimburse them for longer hospitalizations and for the additional care of patients who have been injured by medical errors and unexpected outcomes. In a scenario like this, it is easy to see that hospitals lack a financial incentive to reduce medical error rates.

If you believe that you or a family member were injured as the result of medical negligence, contact Morrow Kidman Tinker Macey-Cushman, PLLC to discuss your situation.