Study: More kids with asthma end up in hospital when meds cost moreOther reports have shown a link between higher out-of-pocket spending requirements and reduced use of health care services in adults, said Pinar Karaca-Mandic, a public health researcher at the University of Minnesota. But the new study is one of the first to show the relationship in health care for kids.
By: Christopher Snowbeck, St. Paul Pioneer Press
As health plans shift more costs to patients, more children ages 5 to 18 go without needed asthma medicines and wind up in the hospital, a new University of Minnesota study found.
Other reports have shown a link between higher out-of-pocket spending requirements and reduced use of health care services in adults, said Pinar Karaca-Mandic, a public health researcher at the University of Minnesota. But the new study is one of the first to show the relationship in health care for kids.
"Our study suggests that greater prescription medication cost sharing among children with asthma may lead to small reductions in use of important medications with unintended consequences of more frequent asthma-related hospitalizations," researchers write in an article scheduled for publication today in the Journal of the American Medical Association.
The study found that the increased cost of caring for kids in the hospital largely was offset by the decreased cost of medications for those same children, Karaca-Mandic said. Even so, parents and children would be better off avoiding the hospitalizations.
"It's an experience that nobody wants to go through," Karaca-Mandic said. "So, the dollars aside, you're missing school, you're missing work, you're foregoing the quality of your life for some time."
The results point to a mismatch between the price and need for asthma medications, writes Wendy Ungar of the University of Toronto in an accompanying editorial.
Health plans should design benefits in ways that don't discourage patients from getting and taking their medications as prescribed, according to Ungar.
"Other drug policies, such as those governing the Quebec provincial drug plan, have abolished cost sharing for children's prescription medications," Ungar writes.
The study looked at insurance claims for 8,834 U.S. children who began treatment for asthma between 1997 and 2007. About two-thirds of the kids were ages 5 to 18.
When out-of-pocket costs for these kids were $100 or less, their asthma prescriptions were filled 41.7 percent of the days during the first year of treatment. But when out-of-pocket costs were $190 or higher, the filled prescription rate was 40.3 percent.
Children ages 5 to 18 in the study with lower out-of-pocket medicine costs were hospitalized for asthma-related problems at a rate of 1.7 per 100 children. Kids with higher out-of-pocket costs, meanwhile, were hospitalized at a rate of 2.4 per 100 children.
The study found that children younger than 5 got their medicines and avoided hospitalizations at the same rate no matter what level of out-of-pocket spending was required by health plans.
"Younger kids clinically may have more severe disease," Karaca-Mandic said, adding that parents may be more involved with managing the care of younger kids with asthma.
Other studies have shown how the lack of health insurance coverage can have a negative impact on children's health care, Karaca-Mandic said. The study on asthma medicines shows, however, that quality of care is not simply a function of whether a child is covered by insurance.
The richness of benefits within a health plan, the study suggests, can translate into higher or lower use of needed medical services in children.
Overall, the study found a relatively low use of asthma medications across all children. Reducing out-of-pocket medication costs alone won't solve that problem, researchers concluded.
"Other strategies to improve medication use, such as routine access to primary care and pulmonary specialists, written plans of care for families, and regularly scheduled follow-up appointments, may be important," the researchers write.
Distributed by MCT Information Services