186 lines
6 KiB
YAML
186 lines
6 KiB
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'
|