Advertisement

The Impact of Health Insurance Gaps on Access to Care Among Children with Asthma in the United States

  • Jill S. Halterman
    Correspondence
    Address correspondence to Jill S. Halterman, MD, MPH, Associate Professor of Pediatrics, University of Rochester School of Medicine, Box 777, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, New York 14642.
    Affiliations
    From the Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children's Research Center, Rochester, NY (Dr Halterman, Dr Montes, Dr Shone, and Dr Szilagyi); and Children's Institute, Rochester, NY (Dr Halterman and Dr Montes)
    Search for articles by this author
  • Guillermo Montes
    Affiliations
    From the Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children's Research Center, Rochester, NY (Dr Halterman, Dr Montes, Dr Shone, and Dr Szilagyi); and Children's Institute, Rochester, NY (Dr Halterman and Dr Montes)
    Search for articles by this author
  • Laura P. Shone
    Affiliations
    From the Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children's Research Center, Rochester, NY (Dr Halterman, Dr Montes, Dr Shone, and Dr Szilagyi); and Children's Institute, Rochester, NY (Dr Halterman and Dr Montes)
    Search for articles by this author
  • Peter G. Szilagyi
    Affiliations
    From the Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children's Research Center, Rochester, NY (Dr Halterman, Dr Montes, Dr Shone, and Dr Szilagyi); and Children's Institute, Rochester, NY (Dr Halterman and Dr Montes)
    Search for articles by this author

      Background

      Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers.

      Objective

      The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma.

      Methods

      The National Survey of Children's Health provided parent-report data for 8097 children with asthma. We identified children with continuous public or continuous private insurance and defined 3 groups with gaps in insurance coverage: those currently insured who had a lapse in coverage during the prior 12 months (gained insurance), those currently uninsured who had been insured at some time during the prior 12 months (lost insurance), and those with no health insurance at all during the prior 12 months (full-year uninsured).

      Results

      Thirteen percent of children had coverage gaps (7% gained insurance, 4% lost insurance, and 2% were full-year uninsured). Many children with gaps in coverage had unmet needs for care (7.4%, 12.8%, and 15.1% among the gained insurance, lost insurance, and full-year uninsured groups, respectively). In multivariate models, we found significant associations between insurance gaps and every indicator of poor access to care among this population.

      Conclusions

      Many children with asthma have unmet health care needs and poor access to consistent primary care, and lack of continuous health insurance coverage may play an important role. Efforts are needed to ensure uninterrupted coverage for these children.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Newacheck P.W.
        • Halfon N.
        Prevalence, impact, and trends in childhood disability due to asthma.
        Arch Pediatr Adolesc Med. 2000; 154: 287-293
        • NIAID
        Asthma: A Concern for Minority Populations.
        National Institute of Allergy and Infectious Diseases, Bethesda, MD1996
        • Juniper E.F.
        • Guyatt G.H.
        • Feeny D.H.
        • et al.
        Measuring quality of life in the parents of children with asthma.
        Qual Life Res. 1996; 5: 27-34
        • Lozano P.
        • Sullivan S.D.
        • Smith D.H.
        • Weiss K.B.
        The economic burden of asthma in US children: estimates from the National Medical Expenditure Survey.
        J Allergy Clin Immunol. 1999; 104: 957-963
        • Weiss K.B.
        • Gergen P.J.
        • Hodgson T.A.
        An economic evaluation of asthma in the United States.
        N Engl J Med. 1992; 326: 862-866
      1. American Thoracic Society. Targeting IgE in the treatment of asthma and other allergic diseases. Highlights from a symposium of the same title held during the 96th International Conference of the American Thoracic Society, 2000. Available at: http://www.cdc.gov/asthma/program.htm. Accessed November 13, 2007.

        • Carr W.
        • Zeitel L.
        • Weiss K.
        Variations in asthma hospitalizations and deaths in New York City.
        Am J Public Health. 1992; 82: 59-65
        • Weiss K.B.
        • Wagener D.K.
        Changing patterns of asthma mortality. Identifying target populations at high risk.
        JAMA. 1990; 264: 1683-1687
        • Akinbami L.J.
        • Schoendorf K.C.
        Trends in childhood asthma: prevalence, health care utilization, and mortality.
        Pediatrics. 2002; 110: 315-322
        • National Asthma Education and Prevention Program
        NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002.
        National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Md2002 (NIH Publication No. 02-5075)
        • Donahue J.G.
        • Weiss S.T.
        • Livingston J.M.
        • et al.
        Inhaled steroids and the risk of hospitalization for asthma.
        JAMA. 1997; 277: 887-891
        • Kelly C.S.
        • Morrow A.L.
        • Shults J.
        • et al.
        Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in medicaid.
        Pediatrics. 2000; 105: 1029-1035
        • Guevara J.P.
        • Wolf F.M.
        • Grum C.M.
        • Clark N.M.
        Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis.
        BMJ. 2003; 326: 1308-1309
        • Schatz M.
        • Zeiger R.S.
        • Mosen D.
        • et al.
        Improved asthma outcomes from allergy specialist care: a population-based cross-sectional analysis.
        J Allergy Clin Immunol. 2005; 116: 1307-1313
        • Diaz T.
        • Sturm T.
        • Matte T.
        • et al.
        Medication use among children with asthma in East Harlem.
        Pediatrics. 2000; 105: 1188-1193
        • Homer C.J.
        • Szilagyi P.
        • Rodewald L.
        • et al.
        Does quality of care affect rates of hospitalization for childhood asthma?.
        Pediatrics. 1996; 98: 18-23
        • Ordonez G.A.
        • Phelan P.D.
        • Olinsky A.
        • Robertson C.F.
        Preventable factors in hospital admissions for asthma.
        Arch Dis Child. 1998; 78: 143-147
        • Halterman J.S.
        • Aligne C.A.
        • Auinger P.
        • et al.
        Inadequate therapy for asthma among children in the United States.
        Pediatrics. 2000; 105: 272-276
        • Crain E.F.
        • Kercsmar C.
        • Weiss K.B.
        • et al.
        Reported difficulties in access to quality care for children with asthma in the inner city.
        Arch Pediatr Adolesc Med. 1998; 152: 333-339
        • Eggleston P.A.
        • Malveaux F.J.
        • Butz A.M.
        • et al.
        Medications used by children with asthma living in the inner city.
        Pediatrics. 1998; 101: 349-354
        • Kattan M.
        • Mitchell H.
        • Eggleston P.
        • et al.
        Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma Study.
        Pediatr Pulmonol. 1997; 24: 253-262
        • Gottlieb D.J.
        • Beiser A.S.
        • O'Connor G.T.
        Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston.
        Chest. 1995; 108: 28-35
        • Warman K.L.
        • Silver E.J.
        • McCourt M.P.
        • Stein R.E.
        How does home management of asthma exacerbations by parents of inner-city children differ from NHLBI guideline recommendations? National Heart, Lung, and Blood Institute.
        Pediatrics. 1999; 103: 422-427
        • Newacheck P.W.
        • Stoddard J.J.
        • Hughes D.C.
        • Pearl M.
        Health insurance and access to primary care for children.
        N Engl J Med. 1998; 338: 513-519
        • Kogan M.D.
        • Alexander G.R.
        • Teitelbaum M.A.
        • et al.
        The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States.
        JAMA. 1995; 274: 1429-1435
        • Newacheck P.W.
        • Hughes D.C.
        • Cisternas M.
        Children and health insurance: an overview of recent trends.
        Health Aff (Millwood). 1995; 14: 244-254
        • Holl J.L.
        • Szilagyi P.G.
        • Rodewald L.E.
        • et al.
        Profile of uninsured children in the United States.
        Arch Pediatr Adolesc Med. 1995; 149: 398-406
        • Weissman J.S.
        • Stern R.
        • Fielding S.L.
        • Epstein A.M.
        Delayed access to health care: risk factors, reasons, and consequences.
        Ann Intern Med. 1991; 114: 325-331
        • Dey A.N.
        • Schiller J.S.
        • Tai D.A.
        Summary health statistics for U.S. children: National Health Interview Survey, 2002.
        Vital Health Stat 10. 2004; : 1-78
        • Guendelman S.
        • Pearl M.
        Access to care for children of the working poor.
        Arch Pediatr Adolesc Med. 2001; 155: 651-658
        • Olson L.M.
        • Tang S.F.
        • Newacheck P.W.
        Children in the United States with discontinuous health insurance coverage.
        N Engl J Med. 2005; 353: 382-391
        • Satchell M.
        • Pati S.
        Insurance gaps among vulnerable children in the United States, 1999-2001.
        Pediatrics. 2005; 116: 1155-1161
        • Aiken K.D.
        • Freed G.L.
        • Davis M.M.
        When insurance status is not static: insurance transitions of low-income children and implications for health and health care.
        Ambul Pediatr. 2004; 4: 237-243
        • Halterman J.
        • Auinger P.
        • Conn K.M.
        • et al.
        Inadequate therapy and poor symptom control among children with asthma: findings from a multi-state sample.
        Ambul Pediatr. 2007; 7: 153-159
        • Blumberg S.J.
        • Olson L.
        • Frankel M.R.
        • Osborn L.
        • Srinath K.P.
        • Giambo P.
        Design and operation of the National Survey of Children's Health.
        Vital Health Stat 10. 2005; 1
        • Medical Home Initiatives for Children with Special Project Advisory Committee
        Policy statement: organizational principles to guide and define the child health care system and/or improve the health of all children.
        Pediatrics. 2004; 113: 1545-1547
        • Liu C.
        • Zaslavsky A.M.
        • Ganz M.L.
        • et al.
        Continuity of health insurance coverage for children with special health care needs.
        Matern Child Health J. 2005; 9: 363-375
        • Wood P.R.
        • Smith L.A.
        • Romero D.
        • et al.
        Relationships between welfare status, health insurance status, and health and medical care among children with asthma.
        Am J Public Health. 2002; 92: 1446-1452
        • Sin D.D.
        • Svenson L.W.
        • Cowie R.L.
        • Man S.F.
        Can universal access to health care eliminate health inequities between children of poor and nonpoor families?: a case study of childhood asthma in Alberta.
        Chest. 2003; 124: 51-56
        • Lara M.
        • Allen F.
        • Lange L.
        Physician perceptions of barriers to care for inner-city Latino children with asthma.
        J Health Care Poor Underserved. 1999; 10: 27-44
        • Szilagyi P.G.
        • Rodewald L.E.
        • Savageau J.
        • et al.
        Improving influenza vaccination rates in children with asthma: a test of a computerized reminder system and an analysis of factors predicting vaccination compliance.
        Pediatrics. 1992; 90: 871-875
        • Warman K.L.
        • Jacobs A.M.
        • Silver E.J.
        If we prescribe it, will it come? Access to asthma equipment for Medicaid-insured children and adults in the Bronx, NY.
        Arch Pediatr Adolesc Med. 2002; 156: 673-677
        • Barrett J.C.
        • Gallien E.
        • Dunkin J.
        • Ryan L.
        Managing asthma within the context of the rural family.
        Public Health Nurs. 2001; 18: 385-391
        • Grupp-Phelan J.
        • Lozano P.
        • Fishman P.
        Health care utilization and cost in children with asthma and selected comorbidities.
        J Asthma. 2001; 38: 363-373
        • Lewis C.E.
        • Lewis M.A.
        Evaluation and implementation of self-management programs for children with asthma.
        J Allergy Clin Immunol. 1987; 80: 498-500
        • Szilagyi P.G.
        • Dick A.W.
        • Klein J.D.
        • et al.
        Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.
        Pediatrics. 2006; 117: 486-496
        • Shone L.P.
        • Dick A.W.
        • Klein J.D.
        • et al.
        Reduction in racial and ethnic disparities after enrollment in the State Children's Health Insurance Program.
        Pediatrics. 2005; 115: e697-e705
      2. Dubay L, Haley J, Kenney J. Children's Eligibility for Medicaid and SCHIP: A View from 2000. The Urban Institute, Report Series B, No. B-41, March 2002. Washington, DC.

        • Shone L.P.
        • Szilagyi P.G.
        The State Children's Health Insurance Program.
        Curr Opin Pediatr. 2005; 17: 764-772
        • Szilagyi P.
        Care of children with special health care needs.
        Future Child. 2003; 13: 137-151
      3. Rosenbach M, Ellwood M, Irvin C, et al. Implementation of the State Children's Health Insurance Program: synthesis of state evaluations. Background for the Report to Congress; March, 2003. MPR Reference No.: 8644-100. Mathematica Policy Research, Cambridge, MA.

        • Dick A.W.
        • Brach C.
        • Allison R.A.
        • et al.
        SCHIP's impact in three states: how do the most vulnerable children fare?.
        Health Aff (Millwood). 2004; 23: 63-75
        • Suissa S.
        • Ernst P.
        • Benayoun S.
        • et al.
        Low-dose inhaled corticosteroids and the prevention of death from asthma.
        N Engl J Med. 2000; 343: 332-336