Journal of General Internal Medicine

, Volume 17, Issue 12, pp 905–913

Insurance and quality of care for adults with acute asthma

  • Timothy G. Ferris
  • David Blumenthal
  • Prescott G. Woodruff
  • Sunday Clark
  • Carlos A. CamargoJr.
  • the MARC Investigators
Original Articles


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.

Key words

asthma acute asthma emergency department primary care quality insurance managed care length of stay uninsured Medicaid 


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Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Timothy G. Ferris
    • 1
  • David Blumenthal
    • 1
  • Prescott G. Woodruff
    • 4
  • Sunday Clark
    • 2
  • Carlos A. CamargoJr.
    • 2
    • 3
  • the MARC Investigators
  1. 1.the Institute for Health Policy, Division of General MedicineMassachusetts General Hospital, Partners HealthCare System and Harvard Medical SchoolBoston
  2. 2.the Department of Emergency MedicineMassachusetts General HospitalBoston
  3. 3.Channing Laboratory, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBoston
  4. 4.the Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of California at San FranciscoSan Francisco

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