Insurance status
Bratton et al. describe an association between the outcomes of patients admitted to the PICU and their insurance status33. The primary goal of this retrospective cohort, including the data of fourteen PICU’s, was to determine whether there was an association between insurance status and PICU LOS, as well as the length of mechanical ventilation in children admitted with asthma. They found that children admitted with severe asthma with a public health insurance were significantly more likely to not only receive mechanical ventilation, but also had longer use of mechanical ventilation, and a longer LOS compared to the children with the same illness severity yet insured by commercial or Health Maintenance Organization (HMO) insurance33. Also, Epstein et al. reported an association between having government insurance, as opposed to indemnity insurance, and a higher PIM2-score at admission in children with respiratory diseases at the PICU16. Finally, Silber et al. evaluated the effect of both insurance status and ethnicity on outcome34. In this multivariate, matched cohort study across thirty-three states that, among other things, compared the outcome between white and black children who were admitted to the hospital with asthma and had a Medicaid (public health) insurance, it was found that race did not influence re-admissions or deaths. However, they did find a small but significant difference in PICU use and the LOS at the PICU in black children34.