A new study finds that patients with public health insurance are more likely to die from a heart attack than patients with private insurance, pointing to a seeming inequity in the delivery of costly life-saving procedures.

Vice President Dick Cheney's recent hospitalizations underscored the potentially life-saving benefits of advanced medical care following a heart attack .

However, the results of this new study suggest that these life-saving benefits -- which in the case of the vice president's recent surgery cost more than $30,000 -- may not be as readily available to heart patients who don't have the insurance to pay for them.

Death rates after a heart attack vary according to insurance coverage and were lowest for patients with private insurance, says study author Jay J. Shen, Ph.D., of Governors State University in University Park, Illinois

"In general, Medicaid and uninsured [heart attack] patients were about 20 percent and 30 percent more likely to die in the hospital than were Medicare [heart attack] patients, respectively," he says.

Patients with private insurance, however, were 20 percent less likely to die when compared to Medicare patients.

The study is published in the August issue of Health Services Research.

The investigators reviewed records from 95,971 heart attack discharges from hospitals in 11 states with primary diagnosis of either heart attack or presumed heart attack complication. In addition to insurance coverage, the researchers examined the relationship between race and income on death rates from heart attack.

Mortality did not differ between races and reduced income was only modestly associated with increased risk of dying following a heart attack.

However, patients in the "extremely unfavorable group" (those who lived in a low-income area and were either uninsured or covered by Medicaid) not only were more likely to die, but also were sicker, stayed in the hospital longer, were less likely to receive certain procedures for heart disease and had higher hospital bills when compared to private insurance patients who lived in more affluent neighborhoods.

"Patients with inferior insurance status may have other illnesses or more advanced disease as a result of financial limitations on sources and access to primary, preventive or even urgent care," Shen explains.

Changing national policies to promote better medical care for uninsured and underinsured individuals could result in reduced deaths from heart attack for all Americans, says Shen.

In addition to the ethical concerns, he points out that "these data demonstrate that disadvantaged patients experienced greater lengths of hospital stay, greater charges, as well as inferior outcomes. An increased focus on improving treatment of heart attack patients bearing multiple low socioeconomic attributes may be in the public interest from a cost-effectiveness perspective."

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Health Services Research is the bimonthly peer-reviewed journal of the Association for Health Services Research and is owned by Health Research and Educational Trust. For information about the journal, contact Alice Schaller at (510) 643-5439 or email alices@uclink4.berkeley.edu. For copies of the article, contact the Center for the Advancement of Health at 202-387-2829 or e-mail press@cfah.org.