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Higher health insurance cost-sharing impacts asthma care for low-income kids

Date:
May 19, 2014
Source:
The JAMA Network Journals
Summary:
Parents in low-income families were less likely to delay asthma care for their children or avoid taking their children to see a doctor if they had lower vs. higher levels of health insurance cost-sharing. "The Affordable Care Act will do a great deal to reduce the numbers of the uninsured in the United States. However, having insurance is just the first step toward improved access. Health care is still expensive, and obtaining it is still difficult for many in the United States," one expert concludes.

Parents in low-income families were less likely to delay asthma care for their children or avoid taking their children to see a doctor is they had lower vs. higher levels of health insurance cost-sharing.

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The Patient Protection and Affordable Care Act (ACA) includes subsidies to reduce cost-sharing for low-income families. Limited information about the effects of cost-sharing on care for children is available to guide such efforts.

A 2012 telephone survey that included 769 parents of children with asthma (ages 4 to 11 years). The authors examined the frequency of changes in seeking care and financial stress because of costs. Of the children, 25.9 percent were enrolled in Medicaid or the Children's Health Insurance Program; 21.7 percent were commercially insured with household incomes at or below 250 percent of the federal poverty level (FPL); and 18.2 percent had higher cost-sharing levels for all services (e.g. $75 or more for an emergency department visit).

Parents at or below 250 percent of the FPL with lower vs. higher cost-sharing levels were less likely to delay or avoid taking their children to a physician's visit (3.8 percent vs. 31.6 percent) and the emergency department (1.2 percent vs. 19.4 percent) because of cost. Parents with higher incomes and those whose children receive public subsidies (e.g. Medicaid) also were less likely to skip getting care for their children than parents at or below 250 percent of the FPL with higher cost-sharing levels. Overall, 2.6 percent of parents reported switching their child to a cheaper asthma medicine and 9.3 percent used less medicine than prescribed because of the costs. Also, 7.6 percent of parents delayed or avoided taking their child to an office visit and 5.3 percent delayed or avoided an emergency department visit because of costs. Among those who reduced medication use, 41.1% of parents reported that if affected their child's asthma care or overall control. Among those who delayed or avoided any office or emergency department visit, 38.1% and 27.4%, respectively, reported that it affected their child's asthma care or control. Many parents (15.6 percent overall) borrowed money or cut back on necessities to pay for care for their children.

"The ACA's low-income subsidies could reduce these barriers for many families, but millions of dependents for whom employer-sponsored family coverage is unaffordable could remain at risk for cost-related problems because of ACA subsidy eligibility rules."

Editorial: Downside of Increased Cost Sharing

In a related editorial, Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, writes: "Their findings are not surprising, given our prior knowledge about cost sharing."

"The Affordable Care Act will do a great deal to reduce the numbers of the uninsured in the United States. However, having insurance is just the first step toward improved access. Health care is still expensive, and obtaining it is still difficult for many in the United States. As Fung and colleagues have shown us, we cannot ignore cost sharing, especially with respect to lower-income individuals obtaining commercial insurance through the exchanges," Carroll concludes.


Story Source:

The above story is based on materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Vicki Fung, Ilana Graetz, Alison Galbraith, Courtnee Hamity, Jie Huang, William M. Vollmer, John Hsu, Ann Chen Wu. Financial Barriers to Care Among Low-Income Children With Asthma. JAMA Pediatrics, 2014; DOI: 10.1001/jamapediatrics.2014.79
  2. Aaron E. Carroll. The Downside of Increased Cost Sharing. JAMA Pediatrics, 2014; DOI: 10.1001/jamapediatrics.2014.449

Cite This Page:

The JAMA Network Journals. "Higher health insurance cost-sharing impacts asthma care for low-income kids." ScienceDaily. ScienceDaily, 19 May 2014. <www.sciencedaily.com/releases/2014/05/140519170913.htm>.
The JAMA Network Journals. (2014, May 19). Higher health insurance cost-sharing impacts asthma care for low-income kids. ScienceDaily. Retrieved October 23, 2014 from www.sciencedaily.com/releases/2014/05/140519170913.htm
The JAMA Network Journals. "Higher health insurance cost-sharing impacts asthma care for low-income kids." ScienceDaily. www.sciencedaily.com/releases/2014/05/140519170913.htm (accessed October 23, 2014).

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