wow-inequalities/02-data/intermediate/wos_sample/d56ac1bf35c0556dfd47ee795d649186-kuhlthau-k-and-nyma/info.yaml

abstract: 'Objective. This study examines patterns of specialist use among children

  and adolescents by presence of a chronic condition or disability,

  insurance, and sociodemographic characteristics.

  Design. Cross-sectional analysis of national survey data, describing

  rates of specialist use, with logistic regressions to examine

  associations with having a chronic condition or disability, insurance

  status, and sociodemographic variables.

  Setting. The 1999 National Health Interview Survey, a nationally

  representative household survey.

  Participants. Children and adolescents 2 to 17 years old.

  Outcome. Parental/respondent reports of specialist visits based on

  reports of the child having seen or talked to a medical doctor who

  specializes in a particular medical disease or problem about the child''s

  health during the last 12 months.

  Results. Thirteen percent of US children were reported as seeing a

  specialist in the past year. Specialist-visit rates were twice as high

  for children with a chronic condition or disability (26\% vs 10.2\%).

  The specialist utilization rates for children without insurance were

  much lower than those for insured children, but among the children who

  have coverage (private, Medicaid, or other), specialist-utilization

  rates were similar (no statistically significant difference).

  Results of multivariate analyses predicting the use of specialists

  confirm the above-mentioned findings. Additionally, they show that use

  of specialist care was lower among children in the middle age group,

  minorities, children in families between 100\% and 200\% of the federal

  poverty level, and lower parental educational levels. We found no

  difference in specialist-visit rates between rural- and urban-dwelling

  children, by family status, or by gender. Differences in specialist use

  by gatekeeping status are found only among subgroups.

  Conclusions. The results showed that, overall, 13\% of children used a

  specialist in a year. Among the insured, a slightly greater percentage

  of children used such care (15\%). These numbers were slightly lower

  than the 18\% to 28\% of pediatric patients referred per year in 5 US

  health plans, although the sources of data and definitions of specialist

  use differ. Our results showed that 26\% of children with a chronic

  condition or disability who were insured by Medicaid use a specialist.

  Although the data are not directly comparable, this is within the range

  of previous findings showing annual rates by condition of use between

  24\% and 59\%. These findings are consistent also with greater use of

  many different types of health care by children with special health care

  needs.

  Medicaid-utilization rates presented here were similar also to the rates

  found among privately insured children and children with ``other{''''}

  insurance. In our earlier work examining use of specialists by children

  insured by Medicaid, we speculated that Medicaid-insured children might

  face particular difficulty with access (eg, due to transportation or

  language barriers). The findings presented here suggest that children

  insured by Medicaid had no different use of specialists than other

  insured children. We do not know, however, whether similar rates are

  appropriate.

  As predicted, sociodemographic differences were pronounced and followed

  patterns typically found for use of health services. Lower rates of

  specialist use by non-Hispanic blacks and Hispanics remains even,

  controlling for chronic condition/disability, status, insurance, and

  socioeconomic status. This is an important issue that not only needs to

  be addressed in using specialist care but also in many areas in health

  care. It is the near poor who seem to have difficulty accessing care (as

  is evidenced by lower use of specialists). In a study of access to care,

  similar results were found, with those between 125\% and 200\% of the

  federal poverty level being less likely to have a usual source of care.

  This is roughly the population targeted by the State Children''s Health

  Insurance Programs.

  These findings cannot determine whether rates of use are too high or too

  low. Additional work on outcomes for children who do and do not use

  specialist care would further inform the work presented here. Extending

  that work to examine patterns of care including but not limited to

  specialists and generalists would be even better.'
affiliation: 'Kuhlthau, K (Corresponding Author), Harvard Univ, Sch Med, MassGen Hosp
  Children, Dept Pediat,Ctr Child \& Adolescent Hlth Policy, 50 Staniford St,Ste 901,
  Boston, MA 02114 USA.

  Harvard Univ, Sch Med, MassGen Hosp Children, Dept Pediat,Ctr Child \& Adolescent
  Hlth Policy, Boston, MA 02114 USA.

  Harvard Univ, Sch Med, Massachusetts Gen Hosp, Inst Hlth Policy,Dept Med,Div Gen
  Med, Boston, MA USA.

  Commonwealth Fund, Qual Care Underserved Populat, New York, NY USA.'
author: Kuhlthau, K and Nyman, RM and Ferris, TG and Beal, AC and Perrin, JM
author-email: kkuhlthau@partners.org
author_list:
- family: Kuhlthau
  given: K
- family: Nyman
  given: RM
- family: Ferris
  given: TG
- family: Beal
  given: AC
- family: Perrin
  given: JM
da: '2023-09-28'
doi: 10.1542/peds.113.3.e249
eissn: 1098-4275
files: []
issn: 0031-4005
journal: PEDIATRICS
keywords: 'Medicaid; specialist; insurance; pediatric; child; disability; chronic

  condition'
keywords-plus: 'HEALTH-CARE; ETHNIC-DIFFERENCES; ENROLLED CHILDREN; CHRONIC ILLNESS;

  MEDICAID; ADOLESCENTS; ACCESS; GENERALISTS; PREVALENCE; INCOME'
language: English
month: MAR 1
number: '3'
number-of-cited-references: '32'
orcid-numbers: Perrin, James/0000-0002-1810-3708
pages: E249-E255
papis_id: 018d1ffd725fa57f8c9bf6287163152e
ref: Kuhlthau2004correlatesuse
times-cited: '62'
title: Correlates of use of specialty care
type: Article
unique-id: WOS:000189344400059
usage-count-last-180-days: '0'
usage-count-since-2013: '6'
volume: '113'
web-of-science-categories: Pediatrics
year: '2004'