Children with asthma are substantially less likely to see an outpatient specialist if they have Medicaid rather than private health insurance, according to a new study. The study analyzed child-year observations in the Massachusetts All Payer Claims Database from 2014 to 2020. Researchers found that specialty care use was reported in 11.9% of publicly insured observations, compared to 20.6% of privately insured observations (P < 0.001).
Despite children with Medicaid having higher rates of persistent asthma, disparities in specialist care by insurance type were even more striking in this group.
Dr. Kimberley Geissler, lead author from the University of Massachusetts Chan Medical School-Baystate in Springfield, stated, “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.”
Medicaid disproportionately insures kids from minority racial and ethnic groups, who are already at higher risk for asthma and asthma exacerbations. The study revealed that those with Medicaid had a 55% lower likelihood of specialist care (adjusted OR 0.45, 95% CI 0.43-0.47), with a regression-adjusted 9.7-percentage point lower rate compared to the privately insured. For children with persistent asthma, there was a 3.2-percentage point deficit for patients enrolled in MassHealth, which includes Medicaid and the Children’s Health Insurance Program.
Specialist visits were more common for those with persistent asthma (32.2% vs. 10.8% for those without persistent asthma). The majority of specialist care visits were to allergy and immunology physicians (68%), followed by pulmonologists (34%) and otolaryngologists (2.5%). These findings highlight the need to address disparities in access to specialty care for children with asthma, particularly those insured through Medicaid programs.
See “Striking Disparities in Specialty Care for Kids With Asthma on Public Insurance” (June 19, 2024)
