187 lines
6 KiB
YAML
187 lines
6 KiB
YAML
abstract: 'Objective. This study examines patterns of specialist use among children
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and adolescents by presence of a chronic condition or disability,
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insurance, and sociodemographic characteristics.
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Design. Cross-sectional analysis of national survey data, describing
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rates of specialist use, with logistic regressions to examine
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associations with having a chronic condition or disability, insurance
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status, and sociodemographic variables.
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Setting. The 1999 National Health Interview Survey, a nationally
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representative household survey.
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Participants. Children and adolescents 2 to 17 years old.
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Outcome. Parental/respondent reports of specialist visits based on
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reports of the child having seen or talked to a medical doctor who
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specializes in a particular medical disease or problem about the child''s
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health during the last 12 months.
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Results. Thirteen percent of US children were reported as seeing a
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specialist in the past year. Specialist-visit rates were twice as high
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for children with a chronic condition or disability (26\% vs 10.2\%).
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The specialist utilization rates for children without insurance were
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much lower than those for insured children, but among the children who
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have coverage (private, Medicaid, or other), specialist-utilization
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rates were similar (no statistically significant difference).
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Results of multivariate analyses predicting the use of specialists
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confirm the above-mentioned findings. Additionally, they show that use
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of specialist care was lower among children in the middle age group,
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minorities, children in families between 100\% and 200\% of the federal
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poverty level, and lower parental educational levels. We found no
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difference in specialist-visit rates between rural- and urban-dwelling
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children, by family status, or by gender. Differences in specialist use
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by gatekeeping status are found only among subgroups.
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Conclusions. The results showed that, overall, 13\% of children used a
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specialist in a year. Among the insured, a slightly greater percentage
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of children used such care (15\%). These numbers were slightly lower
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than the 18\% to 28\% of pediatric patients referred per year in 5 US
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health plans, although the sources of data and definitions of specialist
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use differ. Our results showed that 26\% of children with a chronic
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condition or disability who were insured by Medicaid use a specialist.
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Although the data are not directly comparable, this is within the range
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of previous findings showing annual rates by condition of use between
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24\% and 59\%. These findings are consistent also with greater use of
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many different types of health care by children with special health care
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needs.
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Medicaid-utilization rates presented here were similar also to the rates
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found among privately insured children and children with ``other{''''}
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insurance. In our earlier work examining use of specialists by children
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insured by Medicaid, we speculated that Medicaid-insured children might
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face particular difficulty with access (eg, due to transportation or
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language barriers). The findings presented here suggest that children
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insured by Medicaid had no different use of specialists than other
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insured children. We do not know, however, whether similar rates are
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appropriate.
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As predicted, sociodemographic differences were pronounced and followed
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patterns typically found for use of health services. Lower rates of
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specialist use by non-Hispanic blacks and Hispanics remains even,
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controlling for chronic condition/disability, status, insurance, and
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socioeconomic status. This is an important issue that not only needs to
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be addressed in using specialist care but also in many areas in health
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care. It is the near poor who seem to have difficulty accessing care (as
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is evidenced by lower use of specialists). In a study of access to care,
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similar results were found, with those between 125\% and 200\% of the
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federal poverty level being less likely to have a usual source of care.
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This is roughly the population targeted by the State Children''s Health
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Insurance Programs.
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These findings cannot determine whether rates of use are too high or too
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low. Additional work on outcomes for children who do and do not use
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specialist care would further inform the work presented here. Extending
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that work to examine patterns of care including but not limited to
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specialists and generalists would be even better.'
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affiliation: 'Kuhlthau, K (Corresponding Author), Harvard Univ, Sch Med, MassGen Hosp
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Children, Dept Pediat,Ctr Child \& Adolescent Hlth Policy, 50 Staniford St,Ste 901,
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Boston, MA 02114 USA.
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Harvard Univ, Sch Med, MassGen Hosp Children, Dept Pediat,Ctr Child \& Adolescent
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Hlth Policy, Boston, MA 02114 USA.
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Harvard Univ, Sch Med, Massachusetts Gen Hosp, Inst Hlth Policy,Dept Med,Div Gen
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Med, Boston, MA USA.
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Commonwealth Fund, Qual Care Underserved Populat, New York, NY USA.'
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author: Kuhlthau, K and Nyman, RM and Ferris, TG and Beal, AC and Perrin, JM
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author-email: kkuhlthau@partners.org
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author_list:
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- family: Kuhlthau
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given: K
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- family: Nyman
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given: RM
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- family: Ferris
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given: TG
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- family: Beal
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given: AC
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- family: Perrin
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given: JM
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da: '2023-09-28'
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doi: 10.1542/peds.113.3.e249
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eissn: 1098-4275
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files: []
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issn: 0031-4005
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journal: PEDIATRICS
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keywords: 'Medicaid; specialist; insurance; pediatric; child; disability; chronic
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condition'
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keywords-plus: 'HEALTH-CARE; ETHNIC-DIFFERENCES; ENROLLED CHILDREN; CHRONIC ILLNESS;
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MEDICAID; ADOLESCENTS; ACCESS; GENERALISTS; PREVALENCE; INCOME'
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language: English
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month: MAR 1
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number: '3'
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number-of-cited-references: '32'
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orcid-numbers: Perrin, James/0000-0002-1810-3708
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pages: E249-E255
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papis_id: 018d1ffd725fa57f8c9bf6287163152e
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ref: Kuhlthau2004correlatesuse
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times-cited: '62'
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title: Correlates of use of specialty care
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type: article
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unique-id: WOS:000189344400059
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usage-count-last-180-days: '0'
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usage-count-since-2013: '6'
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volume: '113'
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web-of-science-categories: Pediatrics
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year: '2004'
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