Children who have asthma and are privately insured have greater access to a specialist than those children who are covered by Medicaid. That’s according to the new study, “Health Insurance Type and Outpatient Specialist Care Among Children With Asthma,” recently published in JAMA Network Open. The disparity was significant, according to the study’s lead author, Kimberley H. Geissler, PhD, associate professor of health policy and management at the University of Massachusetts Chan Medical School-Baystate in Springfield. The one-year study was based on claims data from nearly 200,000 children.
“Because differences in whether a child sees an asthma specialist could contribute to these disparities, better understanding specialist use among both groups of kids may help inform potential solutions,” Dr. Geissler said.
Although primary care physicians often and successfully treat children with asthma, access to a specialist is important. She said many times, pediatric asthma is poorly controlled in low-income and minoritized racial and ethnic groups covered by Medicaid.
In the study, researchers identified children with asthma ages two to 17 using data from the Massachusetts All-Payer Claims Database for the years 2015-2020. The study population included 198,101 children.
Additionally, researchers defined asthma specialist care as having at least one outpatient visit with any asthma diagnosis to a clinician with a code of allergy and immunology, pulmonology or otolaryngology.
According to study results, 66.2% of the child-year observations involved Medicaid and 33.8% involved private insurance. Approximately 15% of the children received asthma specialist care. However, nearly twice as many children with private insurance received asthma specialty care compared to those with Medicaid (20.6% versus 11.9%). Children with Medicaid insurance were 55% less likely to receive asthma specialist treatment than children with private insurance.
Allergy and immunology was the most common care specialty, and the child-years for this specialty among children with Medicaid were less than half of those among children with private insurance (7.1% versus 15.9%).
“Contrary to expectations, disparities in specialist care by insurance type were even more striking in children with persistent asthma,” the researchers wrote.
Additionally, researchers said specialty drugs such as biologics for moderate to severe asthma are often prescribed by specialists, and ensuring access to specialists for children with Medicaid may reduce disparities in asthma control for those with severe or poorly controlled disease.
