Transplants

Switch to public insurance tied to shorter survival after heart transplant

File photo of a heart transplant operation at the Cleveland Clinic in Cleveland.

File photo of a heart transplant operation at the Cleveland Clinic in Cleveland.  (AP Photo/Jamie-Andrea Yanak)

When health insurance changes after a heart transplant, so do survival odds, according to a U.S. study.

Patients who switch from private to public insurance, like Medicare or Medicaid, have shorter lifespans than those who stay with private insurance in the year after the transplant, researchers found. At the same time, people who had public insurance and switched to private in the year after surgery improved their survival odds.

"It was surprising that insurance status changes over a short period of time were indeed associated with heart transplantation outcomes," said lead author Dmitry Tumin of The Ohio State University in Columbus.

"Based on our findings, we suggest that helping people keep their insurance during the transplant process is a policy option that merits further study," Tumin told Reuters Health by email.

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The researchers analyzed data from a United Network for Organ Sharing (UNOS) registry of 11,681 U.S. adults aged 10 to 64 years old who underwent first-time heart transplants between 2006 and 2013.

Of these patients, about one in five changed insurance coverage type between being put on the waiting list for a heart and one year post-transplant. Most patients, 44 percent, had continuous private insurance and 27 percent had continuous public insurance.

Half of patients survived for four years or less after transplant.

Compared to people who had continuous private insurance coverage, those on public insurance had 36 percent higher risk of dying during the follow-up period. Those who transitioned from private to public insurance in the first year after transplant had 25 percent higher risk of death.

People who switched from public to private insurance, however, had a 22 percent lower risk of death than those who were continuously covered by public insurance, according to the results in published September 13 in Circulation: Cardiovascular Quality and Outcomes.

Among people who transitioned to private insurance, only 12 percent died during the study follow-up, compared to 17 percent of those who had continuous public insurance.

The differences in survival remained after researchers adjusted for other factors that might influence transplant survival, including social and economic factors, race, age and other health conditions.

"U.S. transplant centers generally require patients to have some form of insurance before they are waitlisted for a transplant," Tumin said. "Recent studies suggest that transplant recipients with private insurance have better access to care, better adherence to treatment and are favorably selected for characteristics that predict improved survival."

In general, private insurance is associated with better surgical outcomes for a number of procedures, he said.

Insurance coverage identifies different populations, with people on public insurance tending to be younger, to have disabilities, and to be of lower socioeconomic status than others, said Dr. Francis D. Pagani of the University of Michigan in Ann Arbor, who wrote a commentary accompanying the results.

Public insurance coverage may be lesser than private and make it harder to keep buying and taking medications to help your body accept the organ, Pagani told Reuters Health. Also, a switch to public insurance could indicate other changes in a patient's life - maybe she could not go back to work, was less financially stable and had to go on Medicare, he said.

Social workers on transplant teams should help make sure patients can afford their medications, can get to clinic appointments and have necessary transportation, especially when insurance status changes, Pagani said.