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Low income, higher cost-sharing posed barriers to children’s asthma care

Low-income families who had higher cost-sharing health plans were not as proactive in seeking care for children with asthma, when compared with families who had lower levels of cost sharing, according to recent study results.

“We found that lower-income parents of children with asthma were more likely to delay or avoid taking their children to a doctor’s office or to the emergency room if they had to pay higher out-of-pocket costs for care,” researcher Vicki Fung, PhD, assistant professor, department of medicine, Harvard Medical School, told Healio.com. “They were also more likely to report borrowing money to pay for asthma care.”

 

Vicki Fung

Fung and colleagues conducted a telephone survey in 2012 of 769 parents of children with asthma (aged 4 to 11 years; 26.3% females). Public subsidies were received by 25.9% of the children (9.1%, Medicaid; 16.8% Children’s Health Insurance Programs), while 21.7% were commercially insured with household incomes at or below 250% of the federal poverty level (FPL), and 18.2% “had higher cost-sharing levels for all services [eg, at least $75 for ED visits].”

Current receipt of subsidy or potential eligibility for the Affordable Care Act (ACA) low-income sharing or premium subsidies in 2014 and “cost-sharing levels for prescription drugs, office visits and emergency department visits” were used to classify children with asthma.

Parents were asked whether they had switched children’s asthma medication to a cheaper drug, if the child used less medication than prescribed, and if they had avoided physician’s office or ED visits.

“After adjustment, parents at or below 250% of the FPL with lower vs. higher cost-sharing levels were less likely to delay or avoid taking children to a physicians’ office visit (3.8% vs. 31.6%; OR=0.07; 95% CI, 0.01-0.39) and the emergency department (1.2% vs. 19.4%; OR=0.05; 95% CI, 0.01-0.25) because of cost,” the researchers reported.

Children with higher-income parents were more likely to receive care, as were children receiving public subsidies when compared with children whose parents were at or below 250% of the FPL with higher cost-sharing levels.

“Overall, 15.6% of parents, borrowed money or cut back on necessities to pay for their children’s asthma care,” Fung and colleagues reported.

“The [ACA] includes subsidies that reduce out-of-pocket costs for low income families, which could make health care more affordable, especially for families with chronic conditions, such as asthma,” Fung said. “Nevertheless, it will continue to be important to incorporate discussions about costs into clinical encounters, especially when assessing potential barriers to care, even for those with insurance coverage.”

Disclosure: Fung reports financial interest in Merck, which produces a leukotriene inhibitor, one of the asthma regimens assessed in the Population-Based Effectiveness in Asthma and Lung Diseases study.