Higher cost-sharing associated with delayed care for children’s asthma

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1. Low-income families were less likely to delay seeking asthma care for their children if they had lower levels of health insurance cost sharing.

2. Higher income families and those who received public subsidies were also less likely to delay seeking asthma care than parents at or below 250% of the federal poverty line.

Evidence Rating Level: 3 (Average)

Study Rundown: The cost of health insurance can be prohibitive for some families. Many private insurance plans require patients to pay a portion themselves (cost sharing). While higher levels of cost sharing can reduce unnecessary care, it can also prevent individuals from appropriately seeking care. This study examined whether the amount of cost sharing was related to parents seeking care for their children’s asthma. It was found that low-income families were less likely to delay seeking care for their child’s asthma, and less likely to avoid taking their child to see a doctor if they had lower levels of cost sharing.

Strengths of this study included a large number of parents polled, including a large number receiving public subsidies and with incomes at or below 250% of the federal poverty line (FPL). The study was limited by its survey design, which was dependent on parent response, which may be unreliable or biased. Data on financial stress was collected indirectly by asking if parents had borrowed money or cut back on other necessities. Patients who could not complete the survey in English were also excluded.

Click to read the study in JAMA Pediatrics

Relevant Reading: Prescription Drug Cost Sharing Associations With Medication and Medical Utilization and Spending and Health

In-Depth [survey]: This survey conducted at Kaiser Permanente Northern California, an integrated health delivery system. Patients were aged 4 to 11 years. Children with concurrent diagnoses of cystic fibrosis and other comorbidities were excluded. 1400 parents were contacted to complete a survey, and were asked if they had changed their child’s medications or skipped doses due to cost. They were also asked if they avoided taking their child to the physician or ED due to cost. Financial stress was assessed by asking if they had to borrow money from friends/family, credit card, or had to cut back on necessities because of the cost of their child’s asthma care. Cost sharing levels for asthma drugs were obtained from membership data.

Parents at or below 250% of the FPL with lower cost sharing levels were less likely to delay or avoid taking their child to the physician due to cost (3.8% vs 31.6%, OR 0.07, 95% CI 0.01-0.39). Parents with higher incomes and those receiving public subsidies such as Medicaid were also less likely to delay care. For parents who reduced medication use, 41.1% stated it affected their child’s asthma care or control. For parents who avoided a physician office or ED visit, 38.1% and 27.4% stated it affected their child’s asthma care or control. 15.6% of families overall stated they borrowed money or cut back on necessities due to the cost of their child’s asthma care.

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