Health Insurance Type and Outpatient Specialist Care Among Children With Asthma

Author:

Geissler Kimberley H.1,Shieh Meng-Shiou1,Krishnan Jerry A.234,Lindenauer Peter K.156,Ash Arlene S.6,Goff Sarah L.7

Affiliation:

1. Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield

2. Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago

3. Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago

4. Office of Population Health Sciences, University of Illinois Chicago

5. Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield

6. Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester

7. Department of Health Promotion and Policy, School of Public Health & Health Sciences, University of Massachusetts Amherst

Abstract

ImportanceAlthough children with asthma are often successfully treated by primary care clinicians, outpatient specialist care is recommended for those with poorly controlled disease. Little is known about differences in specialist use for asthma among children with Medicaid vs private insurance.ObjectiveTo examine differences among children with asthma regarding receipt of asthma specialist care by insurance type.Design, Setting, and ParticipantsIn this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children’s Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024.ExposureMedicaid vs private insurance.Main Outcomes and MeasuresThe primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time.ResultsAmong 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, −10.4 percentage points to −9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma.Conclusions and RelevanceIn this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.

Publisher

American Medical Association (AMA)

Reference55 articles.

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4. Comparisons of health care utilization outcomes in children with asthma enrolled in private insurance plans versus Medicaid.;Chang;J Pediatr Health Care,2014

5. Racial and ethnic disparities in acute care use for pediatric asthma.;Kaufmann;Ann Fam Med,2022

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