Key result
Private health insurance is not associated with lower early mortality after cardiac surgery versus statutory insurance.
Why the study?
Data on potential outcome differences between statutory and private health insurance patients undergoing cardiac surgery in Germany are scarce despite known differences in benefits and access.
Does statutory versus private health insurance status affect early mortality and hospitalization outcomes in patients undergoing cardiac surgery?
Observational (n=2,238)
No
Does statutory versus private health insurance status affect early mortality and hospitalization outcomes in patients undergoing cardiac surgery?
In Germany, insurance status does not appear to significantly impact early mortality following cardiac surgery, though private insurance is associated with shorter hospital stays and surgery by more senior staff.
Small observational German cohort leaves open whether PHI vs SHI affects outcomes in high-morbidity care; larger studies needed before practice or policy shifts.
Background: In all, 90% of patients in Germany are insured with statutory (SHI) instead of private health insurance (PHI). PHI offers significantly better benefits including earlier and more comprehensive diagnosis and therapy, which can reduce the complication rate and even mortality in fields where patients with high morbidity are treated, yet data on potential outcome differences between SHI and PHI patients in Germany is scarce. Methods: Between January 2023 and December 2025, 144 PHI and 2094 SHI patients underwent heart surgery at one institution. Preoperative baseline characteristics, risk factors, and peri- and postoperative information, including the surgeon’s experience level and distance of the referring hospital, were retrospectively compared. In addition, a propensity score matching (PSM) analysis was performed. Results: The SHI group presented with significantly higher BMI and EuroSCORE II, fewer male patients and higher NYHA states. Significantly more PHI patients were operated on by very senior staff members and none by a trainee, and their hospitalization time was significantly shorter. Neither early mortality (PHI 3.47%, SHI 5.35%, p = 0.432) nor distance levels of referring hospitals differed significantly. After PSM, only differences in the hospitalization time and surgical experience level remained significant. Early mortality came down to 4.86% in the SHI patients after PSM. Conclusions: In a multimorbid patient group, we found no evidence for a difference in outcome depending on insurance status, aside from a shorter hospital stay for PHI patients. Nonetheless, the situation in the pre- and post-hospital phases for SHI patients may have room for improvement. Efforts should be made to give all patients the same rapid and comprehensive access to healthcare services, increasing the system satisfaction of patients with SHI. In cardiac surgery, fortunately, there is no particular need for adjustments regarding the in-hospital phase.
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Tsegmid et al. (2026) conducted an observational in Cardiac Surgery (n=2,238). Private health insurance vs. Statutory health insurance was evaluated on Early mortality (p=0.432). Private health insurance was not associated with a significant difference in early mortality after cardiac surgery compared to statutory health insurance (3.47% vs 5.35%; P=0.432).
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