title: Health insurance status and outcomes of critically ill obstetric patients: a prospective cohort study in Argentina.
abstract: OBJECTIVE
  In Argentina, uninsured patients receive public health care, and the insured receive private health care. Our aim was to compare different outcomes between critically ill obstetric patients from both sectors.
  
  
  METHODS
  This is a prospective cohort, including pregnant/postpartum patients requiring admission to 1 intensive care unit in the public sector (uninsured) and 1 in the private (insured) from January 1, 2008, to September 30, 2011.
  
  
  RESULTS
  A total of 151 patients were included in the study. In uninsured (n = 63) vs insured (n = 88) patients, Acute Physiology and Chronic Evaluation II (APACHE II) and Sequential Organ Failure Assessment scores were 11 ± 6.5 vs 8 ± 4 and 3 (2-7) vs 1 (0-2), respectively, and 84% vs 100% received prenatal care (P = .001 for all). Multiple organ dysfunction syndrome (MODS) was present in 32 (54%) uninsured vs 9 (10%) insured patients (P = .001), and acute respiratory distress syndrome developed in 18 (30.5%) of 59 vs 2(2%) of 88 (P = .001). Neonatal survival was 80% vs 96% (P = .003). Variables independently associated with the development of MODS were APACHE II (odds ratio, 1.30 [1.13-1.49]), referral from another hospital (odds ratio, 11.43 [1.86-70.20]), lack of health insurance (odds ratio 6.75 [2.17-20.09]), and shock (odds ratio 4.82 [1.54-15.06]). Three patients died, all uninsured.
  
  
  CONCLUSIONS
  Uninsured critically ill obstetric patients (public sector) were more severely ill on admission and experienced worse outcomes than insured patients (private sector). Variables independently associated with MODS were APACHE II, shock, referral from another hospital, and lack of insurance.
authors.affiliation: Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina; Sanatorio Anchorena, City of Buenos Aires, Argentina; Fundación para la Investigación y Asistencia de la Enfermedad Renal, La Plata, Buenos Aires, Argentina. Electronic address: daniela.vasquez@alumni.utoronto.ca.
authors.forename: Daniela N
authors.initials: DN
authors.lastname: Vasquez
authors.affiliation: Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina; Fundación para la Investigación y Asistencia de la Enfermedad Renal, La Plata, Buenos Aires, Argentina.
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Das Neves
authors.affiliation: Sanatorio Anchorena, City of Buenos Aires, Argentina.
authors.forename: Vanina B
authors.initials: VB
authors.lastname: Aphalo
authors.affiliation: Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina.
authors.forename: Cecilia I
authors.initials: CI
authors.lastname: Loudet
authors.affiliation: Fundación para la Investigación y Asistencia de la Enfermedad Renal, La Plata, Buenos Aires, Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Roberti
authors.affiliation: Fundación para la Investigación y Asistencia de la Enfermedad Renal, La Plata, Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Cicora
authors.affiliation: Sanatorio Anchorena, City of Buenos Aires, Argentina.
authors.forename: Matias
authors.initials: M
authors.lastname: Casanova
authors.affiliation: Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina.
authors.forename: Hector S
authors.initials: HS
authors.lastname: Canales
authors.affiliation: Sanatorio Anchorena, City of Buenos Aires, Argentina.
authors.forename: Alfredo D
authors.initials: AD
authors.lastname: Intile
authors.affiliation: Sanatorio Anchorena, City of Buenos Aires, Argentina.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Scapellato
authors.affiliation: Sanatorio Anchorena, City of Buenos Aires, Argentina.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Desmery
authors.affiliation: Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina.
authors.forename: Elisa
authors.initials: E
authors.lastname: Estenssoro
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D001118:Argentina / Q000453:epidemiology; D015331:Cohort Studies; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D017149:Private Sector / Q000706:statistics & numerical data*; D011446:Prospective Studies; D017150:Public Sector / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000401:mortality; D012720:Severity of Illness Index; D012769:Shock / Q000401:mortality
keywords: Critical care; Insurance; Pregnancy; Pregnancy outcome; Private sector; Public sector