October 5, 2001

A team led by MGH researchers has found that children with asthma receive similar quality care under both managed care and indemnity insurance plans. In fact, the researchers note, managed care might be the better option. The results of the team's study are published in the Sept./Oct. issue of Ambulatory Pediatrics.

"Overall, we found plenty of room for improvement in the care of children with asthma, but comparing types of insurance had some interesting results," says lead author Timothy G. Ferris, MD, MPH, of MassGeneral Hospital for Children. "We found no evidence of worse quality of care for children with managed care who present to an emergency department with acute asthma."

Between children covered by indemnity or managed care plans, the only significant difference was that those with managed care were more likely to see their primary care physician before going to the emergency department. Ferris says, "This provides evidence that managed care may effectively be shunting cases away from the emergency department and to the primary care physician." The evidence is important because patients with asthma often use the emergency department inappropriately for treatment.

The researchers found that managed care patients seen in the emergency department were more acutely ill than patients with other types of insurance, but they also had similar lengths of stay in the hospital and similar likelihood of having persistent symptoms. "If the outcomes were worse for managed care patients, we'd be concerned that managed care restrictions on emergency department use were hurting patients with asthma," Ferris says.

Medicaid patients appeared to have worse quality of care that those with other types of insurance, but that difference disappeared when factors such as parent income and education were taken into account. Uninsured patients received the poorest quality of care.

The study was conducted by the Multicenter Airway Research Collaboration, led by Carlos Camargo Jr., MD, of the MGH Emergency Department. Other coauthors include Linda Wang, MD, and Sunday Clark, MPH, both of the MGH Emergency Department, and Emily Oken, MD, of BWH.