美国外科医生协会杂志最近发表的文章指出，与仅享受政府提供的医保之接受心脏瓣膜置换术（heart valve replacement surgery）的患者比较，同时享受政府提供的医保和个人购买了私人医疗保险的患者，不仅接受同类手术的预后更好，而且住院时间较短和费用较低。尽管该文并未深入地分析为何存在这些差异，但这些事实至少提醒人们，如可能应该购买各自的医疗保险。

Privately insured heart patients had best outcomes

By Debra Sherman

CHICAGO (Reuters) - Patients who had heart valve replacement surgery who were privately insured had better medical outcomes than the uninsured and Medicaid patients undergoing the same procedure, researchers said on Friday.

As a result, the type of primary insurance should be considered an independent risk factor as patients and doctors weigh risks for surgery, they concluded.

The study, published in the Journal of the American College of Surgeons, found that uninsured and Medicaid status independently increased the risk of in-hospital mortality and the likelihood of complications after the surgery. This was true even after accounting for socioeconomic status, hospital-related and other factors associated with low-income patient groups, they said.

In addition, Medicaid patients accrued the longest average hospital stay and highest total costs.

"The study findings indicate that primary payer status should be considered as an independent risk factor during preoperative patient risk evaluation," said the study's lead author, Dr. Damien LaPar of the University of Virginia Health System.

From 2007 to 2008, the number of uninsured Americans rose by 600,000. Patients covered by Medicaid and Medicare, the U.S. government assistance insurance programs, increased by 4.4 million, while the number of Americans covered by private health insurance fell by 1 million.

Previous research has shown that Medicaid and uninsured patients have worse outcomes than privately insured patients after medical admissions.

While there have been studies on insurance status as a predictor of disease and the differences in allocation of surgical treatment as a function of the type of insurance a patient has, no study has fully examined the impact of the type of insurance on patients undergoing cardiac valve procedures, nor have they been evaluated in a national database, researchers noted.

The study examined 477,932 patients undergoing heart valve operations over a six-year period using discharge data from the Nationwide Inpatient Sample database.

Patients in each payer group had different income and risk factors. After adjusting for risk factors, the type of insurance a patient had remained a highly significant predictor of mortality, they said.