Abstract
OBJECTIVE: The relationship between health care insurance and quality of medical care remains incompletely studied. We sought to determine whether type of patient insurance is related to quality of care and subsequent outcomes for patients who arrive in the emergency department (ED) for acute asthma.
DESIGN: Using prospectively collected data from the Multicenter Airway Research Collaboration, we compared measures of quality of pre-ED care, acute severity, and short-term outcomes across 4 insurance categories: managed care, indemnity, Medicaid, and uninsured.
SETTING AND PARTICIPANTS: Emergency departments at 57 academic medical centers enrolled 1,019 adults with acute asthma.
RESULTS: Patients with managed care ranked first and uninsured patients ranked last on all 7 unadjusted quality measures. After controlling for covariates, uninsured patients had significantly lower quality of care than indemnity patients for 5 of 7 measures and had lower initial peak expiratory flow rates than indemnity insured patients. Patients with managed care insurance were more likely than indemnity-insured patients to identify a primary care physician and report using inhaled steroids in the month prior to arrival in the ED. Patients with Medicaid insurance were more likely than indemnity-insured patients to use the ED as their usual source of care for problems with asthma. We found no differences in patient outcomes among the insurance categories we studied.
CONCLUSIONS: Uninsured patients had consistently poorer quality of care and than insured patients. Despite differences in indicators of quality of care between types of insurance, we found no differences in short-term patient outcomes by type of insurance.
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Dr. Ferris was supported by the Pediatric Scientist Development Program (AAP/HD-00850), and Dr. Camargo by Grant HL-03533 from the National Institutes of Health (Bethesda, Md). The Multicenter Airway Research Collaboration is supported by Grant HL-63253 from the National Institutes of Health, and by unrestricted grants from Glaxo Wellcome, Inc. (Research Triangle Park, NC) and Monaghan Medical Corporation (Syracuse, NY).
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Ferris, T.G., Blumenthal, D., Woodruff, P.G. et al. Insurance and quality of care for adults with acute asthma. J GEN INTERN MED 17, 905–913 (2002). https://doi.org/10.1046/j.1525-1497.2002.20230.x
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DOI: https://doi.org/10.1046/j.1525-1497.2002.20230.x