The purpose of this study was to evaluate whether follow-up treatment varied by private versus public hospital type for patients with ischemic health disease and to identify factors that were associated with differences.

The authors found important differences in follow-up care for such patients when comparing treatment received in one public and one voluntary hospital in New York City. For example, 25% of the public hospital patients versus 73% of the voluntary hospital patients received cardiac catheterization; 50% versus 90% of the public and voluntary patients received exercise stress tests respectively; 6% versus 14% of the public and voluntary patients received coronary artery bypass surgery; and 3% versus 16% of the public and voluntary patients received angioplasty. The patterns were similar when these comparisons were made among patients for whom an external reviewer deemed these procedures appropriate.

While race effects were not directly investigated, the racial pattern in admissions is noteworthy. Among public hospital admissions, 55% were black, 18% were Hispanic, and only 18% were white; while in the voluntary hospital admissions, 11% were black, 8% were Hispanic and 78% were white. This pattern implies that the quality of care for black patients is likely to be substantially lower than for white patients simply because of the type of hospitals to which they are admitted.