Comparisons of health care utilization outcomes in children with asthma enrolled in private insurance plans versus medicaid

Objectives: Very few studies have captured the differences in the outcomes of pediatric patients based on the patients' type of health insurance plan. The purpose of this retrospective cohort study was to examine the impact of the type of health insurance plan (public insurance vs. private insurance) on outcomes (health care utilization and medication adherence) in children with asthma.

Methods: This retrospective cohort study analyzed Medicaid/commercial data from eight states licensed under Thomson Medstat. Subjects were 11,027 children with asthma (6435 enrolled in Medicaid and 4592 enrolled in a commercial health maintenance organization) who newly started asthma pharmacotherapy and were followed up for 12 months before and after the index anti-asthmatic medication fill. Data on health care utilization and medication adherence were examined to compare health care utilization-based outcomes. Quantile regression analysis was used to study medication adherence, and Poisson regression was used to determine health care utilization.

Results: Patients with a private insurance plan had significantly higher medication adherence rates (p < .01) compared with those who had a Medicaid plan. Patients with Medicaid plans also were associated with 20% more inpatient hospitalizations and 48% increased odds of emergency department visits, but they had 42% fewer outpatient visits compared with those who had a private plan (all p < .05).

Conclusion: Children with asthma who are enrolled in Medicaid receive fairly comprehensive coverage of medical services, and thus further research is needed to determine the reasons for poor health care utilization-related outcomes in this population.