No managed care link for stroke-prevention

DALLAS, Dec. 31 (UPI) -- U.S. researchers say in the stroke-prevention surgery, carotid endarterectomy, the checks and balances assumed with managed care did not improve outcomes.

Carotid endarterectomy is a surgical procedure to remove blockages in the neck arteries that can lead to strokes.

Lead author Dr. Ethan Halm of the University of Texas Southwestern in Dallas used data from the New York Carotid Artery Surgery study -- statistics on a patient pool of more than 11,400 cases including information on all Medicare beneficiaries who underwent a carotid endarterectomy between January 1989 and June 1999 in New York state.

The study, completed while Halm was at Mount Sinai School of Medicine in New York, finds there was no difference in rates of inappropriate surgery between managed-care or fee-for-service plans. In managed-care, an insurance company often acts as an intermediary between a person seeking care and the physician, while a fee-for-service plan allows a person to make all healthcare decisions independently.

"There was also no difference in risk-adjusted rates of death or stroke between the plans," Halm says in a statement. "In addition, managed-care patients were less likely to have their procedure performed by a high-volume surgeon or hospital."

The findings are published in the American Journal of Medical Quality.