title: Insurance and quality of care for adults with acute asthma.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Institute for Health Policy, Division of General Medicine, Massachusetts General Hospital, Partners HealthCare System and Harvard Medical School, Boston, Mass. 02114, USA. tferris@partners.org
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.forename: David
authors.initials: D
authors.lastname: Blumenthal
authors.forename: Prescott G
authors.initials: PG
authors.lastname: Woodruff
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics*; D016896:Treatment Outcome