Use of health services by insurance status among children with asthma

OBJECTIVES. It is well known that asthmatic children receiving Medicaid use the emergency department (ED) more frequently than otherwise-insured asthm atic children. However, the extent to which this difference is attributable to provider characteristics, medication use, access to primary care, and s ymptomatology is poorly understood. These factors were explored as independ ent predictors of health care utilization. METHODS. Baseline data from a prospective cohort study of childhood asthma severity were used. Subjects were recruited from seven New England hospital s. Home interviews collected data on monthly symptoms, health care visits, insurance status, as well as sociodemographics and asthma-related risk fact ors (n=804). Characteristics of providers' practices, board certifications, and asthma specialty were obtained from Folio's Medical Dictionaries for C onnecticut and Massachusetts. RESULTS. After adjusting for frequency of asthma-related primary care visit s, primary provider practice type, use of asthma specialist, age, gender, m edication use, and symptom-atology, Medicaid children still used the ED mor e frequently for asthma services than privately insured children (RR, 1.7; 95% CI, 1.1, 2.5). In general, race/ethnicity did not modify the relationsh ip between insurance status and health care use, except that black children receiving Medicaid were 90% (95% Cl, 0.0, 0.7) less likely to have had gre ater than or equal to3 routine primary care visits for asthma in the previo us year than black privately insured children. White children receiving Med icaid were 2.5 (95% CI, 1.0, 6.9) times more likely to use the ED for asthm a than privately insured white children. CONCLUSIONS. The results suggest that enabling, structural, and need factor s do not necessarily explain observed differences in pediatric asthma healt h care use by insurance status. Future investigation must explore other exp lanatory factors such as maternal attitudes and beliefs and patient-provide r communication.