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APHA Scientific Session and Event Listing

Pei-Jung Lin and Leah Masselink. Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB #7411, Chapel Hill, NC 27599-7411, 9199235572, peijung@email.unc.edu

Objectives. About one-sixth of children served by Medicaid or the State Children's Health Insurance Program (SCHIP) have been diagnosed with asthma at some point in their lives. The current study seeks to determine whether Medicaid and SCHIP can provide access to controller medications that ease chronic asthma. Methods. Eight hundred and sixty-two asthmatic children (493.XX, International Classification of Diseases, Clinical Modification, 9th Edition) ages two through eighteen were identified from the 2002 Medical Expenditure Panel Survey datasets. They were assigned to insurance coverage categories (Medicaid/SCHIP or non-Medicaid/SCHIP) based on their responses to the health insurance questions or through logical editing of the survey data. A comprehensive list of anti-inflammatory asthma controller medications, including all generic and brand names, was developed to identify the drugs recommended by the National Heart, Lung, and Blood Institute expert guidelines. In light of potential endogeneity in Medicaid/SCHIP status, simultaneous equations methods were used to specify a two-stage probit model which examined the effect of Medicaid/SCHIP coverage on the probability of obtaining asthma controller medications. An individual's likelihood of obtaining these medicines was also modeled as a function of personal characteristics, including demographic and socioeconomic status, and health conditions. Specification tests were employed to assess the strength of identifying instruments, validity of identifying exclusion restrictions, and the extent of the endogeneity problem. Results. About 13% of the asthmatic children had anti-inflammatory controller medications prescribed to them during 2002, and 45% had Medicaid/SCHIP coverage as defined by the study criteria. The mean age was 9.5 years. These children were approximately 58% male, 70% white, and 48% educated at the elementary school level. The mean probability of having a controller medication prescription was somewhat higher among Medicaid/SCHIP children, but the insurance effect was not statistically significant (β=1.162, p=0.342). Higher healthcare expenditures and school/work absenteeism due to asthma were found to be significantly associated with higher likelihood of obtaining controller medicine (β=0.243, p<0.001; β=0.471, p=0.001, respectively). Conclusions. Medicaid/SCHIP children were equally likely to be prescribed anti-inflammatory controller medications as their counterparts without Medicaid/SCHIP coverage. Considering the fact that lower socioeconomic groups experience disproportionately higher morbidity and mortality due to asthma, the results suggest that the equivalence in controller prescriptions may represent potentially inadequate prescribing of preventive and state-of-the-art medications among those patients in greatest need. In addition to socioeconomic barriers, health care providers and policy makers should target reducing deficiencies in controller medication prescriptions.

Learning Objectives:

• Recognize the importance of controller medication use in managing asthma.
• Describe the effect of Medicaid/SCHIP coverage on obtaining asthma controller medications.
• Discuss whether Medicaid and SCHIP can provide access to controller medications that ease chronic asthma.

Keywords: Asthma, Medicaid

Presenting author's disclosure statement:

Not Answered