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Insurance and quality of care for children with acute asthma
T G Ferris1, E F Crain, E Oken
1Institute for Health Policy, Massachusetts General Hospital, Boston, USA.
Insights
Children with managed care insurance received comparable quality of care and experienced similar outcomes for acute asthma compared to those with indemnity insurance. Uninsured children faced significantly lower quality of care.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Insurance
Background:
- Insurance significantly impacts healthcare quality and outcomes.
- Managed care organizations aim to reduce emergency department (ED) use for acute conditions like asthma.
- Comparisons of care quality across different insurance types are limited.
Purpose of the Study:
- To compare pre-ED care quality, acute asthma severity, and short-term outcomes among children with different insurance types.
- To analyze differences in ED utilization and primary care access based on insurance status.
Main Methods:
- Prospective data from 965 children with acute asthma across 36 EDs.
- Comparison of 7 quality measures, acute severity, and outcomes (length of stay, relapse, ongoing symptoms) across managed care, indemnity, Medicaid, and uninsured groups.
- Multivariate regression controlled for demographic and clinical factors.
Main Results:
- Managed care and indemnity groups showed similar quality of care and outcomes.
- Medicaid and uninsured children had significantly lower quality of care, including less primary care provider (PCP) use and higher ED utilization for asthma.
- Children with managed care presented with more severe acute asthma compared to other groups.
- No significant differences in hospital length of stay, relapse, or ongoing exacerbation were observed across insurance types.
Conclusions:
- Children with managed care insurance receive comparable quality of care and have similar asthma outcomes to those with indemnity insurance.
- Uninsured children consistently experience poorer quality of care.
- Despite higher acute severity, managed care patients did not have worse outcomes than indemnity patients.
Background:
Increasing attention has been paid to the role of insurance in determining quality and outcomes of care. Pressures to reduce health costs and to improve quality have prompted attempts by managed care organizations to decrease the use of the emergency department (ED) for acute asthma, but performance comparisons between insurance types remain rare.
Methods:
We used prospective data from the Multicenter Airway Research Collaboration on 965 children with acute asthma presenting to 36 EDs. We compared measures of quality of pre-ED care, acute severity, and short-term outcomes (length of stay, percent relapse, and percent with ongoing symptoms) across 4 different insurance categories: managed care, indemnity, Medicaid, and uninsured. We used multivariate regression to control for differences in education, estimated income, race/ethnicity, and chronic asthma severity and acute asthma characteristics.
Results:
Children with managed care and indemnity had similar demographic and asthma characteristics, but these children differed significantly from Medicaid and uninsured patients. Managed care and indemnity insured children had similar ratings on all 7 quality measures, with Medicaid and uninsured children ranking significantly lower on most measures, including (1) percent with primary care provider (PCP) (P <.001), (2) percent using ED as usual site of asthma care (P <.001), (3) percent using ED for prescriptions (P <.001), (4) percent with a ratio of >1 of ED visits to acute office visits within the past year (P =.003), and (5) percent visiting their PCP within the week prior to ED visit (P <.001). Children with managed care were more acutely ill than were indemnity, Medicaid, or uninsured children on presentation to the ED (pulmonary index of 4.6, 4.0, 4.2, and 3.9, respectively, P =.007). There were no significant differences in length of hospital stay, relapse, and ongoing exacerbation.
Conclusions:
Our results indicate similar quality of care, greater severity of acute asthma, and no worse outcomes for children with managed care compared to children with indemnity insurance. We found uninsured children to have consistently poorer quality of care than insured patients.