Children with Medicaid and persistent asthma face large specialty care disparity

Children with Medicaid and persistent asthma face large specialty care disparity | Image Credit: © Aliaksandr Marko - © Aliaksandr Marko - stock.adobe.com.

Findings from a recent study published in JAMA Network Open suggest that children with public insurance receive less specialist care compared to those with private insurance, potentially contributing to disparities in asthma outcomes. The largest disparity observed was among children with persistent asthma.

The chronic condition is common among children in the United States and can cause substantial morbidity, especially for children in low-income families, according to the study authors, led by Kimberley H. Geissler, PhD, of the Department of Healthcare Delivery and Population Sciences at the University of Massachusetts Chan Medical School-Baystate.

"Although most children with asthma are successfully treated by primary care clinicians, guidelines recommend an asthma specialist referral when there is poor control despite evidence-based management," the authors noted.

To explore differences in specialist use for asthma among children with Medicaid compared to private insurance, the investigative team conducted a cross-sectional study that included data from the Massachusetts All Payer Claims Database (APCD). Using data from 2014 to 2020, children aged 2 to 17 years were eligible. Analysis was completed from January 2023 to April 2024.

According to the study authors, the primary endpoint of the study was receipt of specialist care defined as any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician. Using multivariable logistic regression models, differences in receipt of specialist care by insurance type were estimated. Characteristics of insurance type included health status, demographics, persistent asthma, calendar year, and zip code. Further analysis evaluated if associations of specialist care with insurance type varied by asthma persistence and severity over time.

Overall, there were 432,455 child-year observations (43.1% female; 48.9% aged 5 to 11 years; 19.0% with persistent asthma [n = 82,108]), of which 66.2% were Medicaid insured and 33.8% were privately insured.

Persistent asthma was more common among child observations with Medicaid (57,381 [20.0%]) compared to private insurance (24,727 [16.9%]) and those with Medicaid were less likely to receive specialist care. In total, 64,239 child-year observations (14.9%) received specialist care, "with substantially lower rates for children with Medicaid vs private insurance," wrote the authors (34,093 vs 30,146).

Disparities were confirmed with regression-based estimates, as children with Medicaid has 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47), with a regression-adjusted 9.7% lower rate of receipt of specialist care (95% CI, −10.4 percentage points to −9.1 percentage points). Among children with persistent asthma, those with Medicaid, compared to children with private insurance, were at an additional 3.2% deficit for specialist care (95% CI, 2.0 percentage points to 4.4 percentage points).

"Our findings suggest children with asthma who have Medicaid receive specialty care at rates significantly lower than children with private insurance, and that this gap is exaggerated further in children with persistent asthma," concluded the study authors.

Reference:

Geissler KH, Shieh M, Krishnan JA, Lindenauer PK, Ash AS, Goff SL. Health insurance type and outpatient specialist care among children with asthma. JAMA Netw Open. 2024;7(6):e2417319. doi:10.1001/jamanetworkopen.2024.17319