Health care use disparities among children with asthma in Puerto Rico

Problem Statement: The use of the hospital Emergency Departments (ED) as primary source of care has been associated with increased morbidity for children with asthma, and has served as indicator of access to care. Given the high asthma prevalence among the pediatric population in Puerto Rico, there is the need to examine ED use patterns. Objective: To compare ED services utilization patterns in pediatric asthma patients by type of insurance. Methods: A secondary data analysis was done that identified patients less than 18 years old with asthma in the claims files (n=75,672) of two insurance company (Fee-For-Service, FFS and Medicaid-Managed Care, MMC). Unadjusted rates of one-year utilization of ED services by insurance status were done. Multiple logistic regression analysis was used to determine the effect of type of insurance on frequent use of ED. Results: There were significant group differences in the rates of ED services use between the insurance groups. The FFS enrollees have considerably more ED visits (3.6-4.8 vs. 1.3 mean visits) than those enrolled in the MMC plan. However, MMC enrollees are three times more likely to use ED services than their counterparts in the FFS group (OR=3.03; 95%CI=2.85-3.22). Conclusions: Our findings support health care ED use disparities between lower socioeconomic status (SES) children (MMC) as compared to FFS, higher SES's asthmatic children in Puerto Rico. Using the ED as primary usual source of care may turn to deficient continuing preventive care hindering the achievement of an effective long-term control of asthma.