Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
Copyright 2000 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2000
In Reply: Dr Ensor and colleagues misinterpret
the mortality rates in Table 1 of our article, which are not adjusted for
severity of illness or other preoperative risk factors. These raw mortality
rates should not be used to compare outcomes of managed care and FFS-insured
patients because the 2 groups of patients are known to differ. Also, while
insurers are not the only participants in the choice of hospital, and patient
convenience (particularly with respect to travel distance) is also an important
factor,1 it is difficult to imagine how
this convenience factor would differ for patients in managed care plans and
those with FFS insurance after controlling for travel distance (the "straight-line"
distance method we used has been shown to correlate highly with actual travel
times).2 There is little reason to believe
that patients with managed care insurance would have a great deal more difficulty
with transportation to hospitals than patients with FFS insurance, particularly
after controlling for relative affluence.
Erickson L. Managed Care Insurance and Use of Higher-Mortality Hospitals—Reply. JAMA. 2000;284(7):829-831. doi:10.1001/jama.284.7.827