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July 9, 1997

Stroke Patients, "Managed Care," and Distributive Justice

Author Affiliations

From the Buehler Center on Aging (Dr Webster) and the Division of General Internal Medicine, Institute for Health Services Research and Policy Studies (Dr Feinglass). Northwestern University Medical School, Chicago, Ill.

JAMA. 1997;278(2):161-162. doi:10.1001/jama.1997.03550020093045

In this issue of The Journal, Retchin and colleagues1 arrive at the disturbing conclusion that Medicare health maintenance organization (HMO) patients treated for stroke were significantly less likely to be discharged to a rehabilitation hospital or return home than clinically similar patients treated in Medicare fee-for-service settings, although mortality was similar. These results imply that some HMO patients may be denied optimal care as a result of their payer status. Is this another example of the new medical environment in which older individuals will be deprived of appropriate care to increase corporate profits or to reward physicians who benefit financially from withholding care?

See also p 119.

This is an especially troublesome matter because stroke is a common illness, affecting more than half a million patients annually and is a leading cause of adult disability in the United States. Stroke takes a devastating physical and emotional toll on patients'