Pediatric Asthma Hospitalizations: Impact of Managed Care in the Patterns of Outpatient Healthcare Utilization

Statement of the problem: Most asthma hospitalizations for children are preventable with adequate disease management described in National Educational Prevention Program (NAEPP). Nevertheless, disparities are observed in health services utilization in Puerto Rican children by insurance coverage.

Objective: To compare outpatient health services utilization patterns by health insurance coverage among children with asthma who at least one hospitalization per year.

Methods: This study explores the patterns of outpatient health care utilization for children under 18 years old diagnosed with asthma reporting at least one hospital admission per year in a group of beneficiaries of the Puerto Rico Health Care Reform (MC, managed care) and those with private insurance (FFS, fee-for-service). A total of 3,250 insurance claims for three years were analyzed.

Results: The FFS enrollees correspond to a higher mean of physician office visits (11 vs. 1), emergency department (ED) visits (3 vs. 1), and number of drug prescriptions (19 vs. 3) than MC group. These trends hold true in the logistic regression analysis where the FFS group show a higher probability of outpatient services use than the MC group with the exception of ED visits. The MC group has a higher probability to visit the ED than the FFS group (OR= 1.5; 95% CI= 1.36-1.60).

Conclusions: These results illustrate differences in the way pediatric asthma patients are treated according to their insurance status. It is vital further research assessing how the system structure, policies of practice sites, adherence to NAEPP guidelines and quality of services impact asthma management.