Cost barriers to asthma care by health insurance type among children with asthma

Abstract

Introduction-Children with asthma have ongoing health care needs and health insurance is a vital part of their health care access. Health care coverage may be associated with various cost barriers to asthma care. We examined cost barriers to receiving asthma care by health insurance type and coverage continuity among children with asthma using the 2012-2014 Child Asthma Call-back Survey (ACBS).Methods-The study sample included 3,788 children under age 18 years with current asthma who had responses to the ACBS by adult proxy. Associations between cost barriers to asthma care and treatment were analyzed by demographic, health insurance coverage, and urban residence variables using multivariable logistic regression models.Results-Among insured children, more blacks reported a cost barrier to seeing a doctor (10.6% [5.9, 18.3]) compared with whites (2.9% [2.1, 4.0]) (p=0.03). Adjusting for demographic factors (sex, age, and race), uninsured and having partial year coverage were associated with cost barrier to seeing a doctor (adjusted prevalence ratio aPR=8. 07 [4.78, 13.61] and aPR=6.58 [3.78, 11.45], respectively) and affording medication (aPR=8. 35 [5.23, 13.34] and aPR=4.93 [2.96, 8.19], respectively), compared with children who had full year coverage. Public insurance was associated with cost barrier to seeing a doctor (aPR=4. 43 [2.57, 7.62]), compared with private insurance.

It’s Just the Fact It’s Against Us: The Role of Social Determinants of Health in Young Children’s Caregivers’ Preventive Health Behaviors

“…Further, children from racial and ethnic groups that are underrepresented and with low family income are at greater risk of having unmet psychological (Coker et al, 2009; Cook et al, 2013; Hodgkinson et al, 2017) and early intervention needs (Feinberg et al, 2011; Rosenberg et al, 2008). Multiple systemic and individual factors impact preventive health behaviors (PHBs) for young children including insurance (Bethell et al, 2011; Pate et al, 2020; Zarrabi et al, 2019) and transportation (Silver et al, 2012; Yang et al, 2006) for accessing health care, income (Lazar & Davenport, 2018), healthcare quality (Bethell et al, 2011), and health literacy (DeWalt & Hink, 2009; Lee et al, 2020; Yin et al, 2014).…”

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“… 38 In our study, lack of treatment by a private physician was likely a surrogate measure for preventive care deficits: previous research has shown that those with public insurance are less likely to receive care from primary providers and specialists because of costs. 9 , 10 , 39 This could lead to a higher incidence of emergency care, which is not restricted by insurance status.…”

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“…Health care access for low-income residents is highly disadvantaged mainly due to cost barriers related to the type of insurance available if they are able to afford it (Pate, Qin, Bailey, & Zahran, 2019). Certain insurances that are affordable for people with low-income may not cover brand name asthma medications; seeing a specialist such as a pulmonologist; or certain medical procedures (Pate, Qin, et al, 2019).…”

“…Health care access for low-income residents is highly disadvantaged mainly due to cost barriers related to the type of insurance available if they are able to afford it (Pate, Qin, Bailey, & Zahran, 2019). Certain insurances that are affordable for people with low-income may not cover brand name asthma medications; seeing a specialist such as a pulmonologist; or certain medical procedures (Pate, Qin, et al, 2019). Warman & Silver (2018) conducted a retrospective cohort study on inner-city children, predominantly African-American and Hispanic 7 to 17 years of age, with poorly controlled asthma from low-income neighborhoods in New York.…”