Pediatric patients with CKD, public health insurance less likely to visit physicians
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Pediatric patients with chronic kidney disease and public health insurance were less likely to report visits to a physician and emergency room than those with private insurance, according to data published in Kidney Medicine.
Further, researchers called for pediatric nephrology programs to direct supportive resources to families with public insurance who may be at risk for suboptimal utilization of health care. Similarly, insurance providers might consider expanding access for families who have children with CKD.
“The contrast between private- and public-based health insurance in terms of health care and dental care utilization has not been adequately studied in children and young adults with CKD, even though disease management and access to clinical care is critical in improving outcomes,” Andrea R. Molino, ScM, from the department of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues wrote. “The aim of this study was to investigate secular trends in health insurance status between 2005 and 2019, and describe health care and dental care utilization by insurance status and potential modifiers in the Chronic Kidney Disease in Children (CKiD) study.”
In an observational cohort study, researchers evaluated 953 patients aged 0.5 to 16 years who attended 4,369 person-visits in the CKiD study. Patients and their families provided data on their current health insurance status, whether it was private, public or no insurance, and clarified if they had dental insurance. Additionally, patients shared if within the past year they attended a private physician visit, if they received care from a dentist or dental hygienist, if they visited the emergency room more than twice or at all within and if they underwent any hospitalizations.
Using repeated measures Poisson regression models, researchers compared utilization by insurance type and disease severity at visits. Researchers conducted additional unadjusted and adjusted models, as well as models addressing interactions between insurance and Black race, maternal education and income.
Overall, 49.2% of patients reported having private health insurance, 49.6% reported having public health insurance and 1.2% reported having none. Likewise, 25.6% of patients reported having no dental insurance at baseline evaluation.
Analyses revealed patients with public health insurance were “more likely to report suboptimal health care utilization across the CKD severity spectrum.” Researchers defined ‘suboptimal health care utilization’ as no visits to a private physician, emergency room or any hospitalizations in the past year. Similarly, those without dental insurance were more likely to report lack of dental care.
“These findings suggest that insurance status may be useful in identifying children requiring additional attention directed to preventive care and support to avoid emergency room visits. We further identified CKD severity as a risk factor for not receiving regular dental care, and that those who lack dental insurance are at risk for suboptimal dental care utilization,” Molino and colleagues wrote. “Pediatric nephrology programs may consider designing or evaluating interventions to direct supportive resources toward these high-risk patients and families. Policy makers may encourage insurance providers to expand access to pediatric CKD preventive care to minimize emergency health care use, and advocate for improving access to services for those with public health insurance.”
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