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[ Recorded presentation ] Recorded presentation

Patterns of health service utilization by insurance status among children and adolescents with asthma in Puerto Rico

Jose Capriles, MD, MPH, MHSA1, Mario H. Rodriguez, PhD, MPH1, Ruth Rios, PhD1, Rene Dávila, MS2, and Yelitza Sánchez, BS1. (1) Puerto Rico Health Services Research Institute, Health Services Administration Department, University of Puerto Rico, School of Public Health, PO Box 365067, San Juan, PR 00936-5067, (787)758-2525, ext 1440, jcapriles@rcm.upr.edu, (2) School of Public Health, Human Development Department, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067

Statement of the problem: Asthma is the most common chronic lung disease diagnosed in children in Puerto Rico and represents an economic burden for direct and indirect costs related to management of the disease.

Objective: To identify health services utilization patterns in pediatric asthma patients by insurance status.

Procedure: This study explores the patterns of health care utilization for people under 18 years old diagnosed with asthma (ICDC: 493.0, 493.1, 493.2, 493.9) in a group of beneficiaries of the Puerto Rico Health Care Reform (MC, managed care) and persons with private insurance (FFS, fee-for-services). Claims files (54,066) of the insurance companies for 1999, 2000 and 2001 were used. Health care utilization was defined in four continuous variables measuring the frequency of visits and/or use of a specific type of service in a year.

Results: The mean of physician office visits for people in the fee-for-service plan was 7.82 (SD=11.95) and 1.52 (SD=1.59) for the people in the managed care plan during the study period. Statistically significant differences were observed for each year of study (p< .001). In the managed care group, use of emergency services was higher (MC=78.8%; FFS=21.2%) than in the fee-for-service group (p< .001). The number of prescription was higher (FFS=56.7%; MC=43.3%) in the fee for service group.

Conclusion: These results illustrate differences in the way children and adolescents are managed and treated according to their insurance status. Provider-specific factors may hold the key to more appropriate access to care.

Learning Objectives:

Keywords: Access to Health Care, Managed Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

[ Recorded presentation ] Recorded presentation

Managed Care: Evaluations of Interventions

The 132nd Annual Meeting (November 6-10, 2004) of APHA