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Study Says Insurance Plays Role in Specialty Care Referrals for Chronically Ill Kids

Children with private insurance are much less likely to be admitted to a specialty care hospital than children with public insurance, researchers in California have found.

A new study by researchers at Lucile Packard Children’s Hospital and the Stanford School of Medicine reveals that children who are chronically ill are much less likely to be admitted to a California hospital that offers specialized pediatric care if they have private insurance.

Lead author Lisa Chamberlain, MD, MPH and senior author Paul Wise, MD, MPH, who are both pediatricians at Packard and professors in the School of Medicine, and their team of researchers examined hospital discharge data from 1999 to 2007. In 2007, children with public insurance occupied the beds at these specialty care centers 67% of the time, compared to 32% of the time for children with private insurance. How far a child lived from a specialty care center played a role in determining whether a child would be hospitalized in one, but geography wasn’t the only factor in the disparity, as “chronically ill children in central California — the counties of Mariposa, Madera, Fresno, and Kings, which are among the poorest in the state — were among the most frequent users of specialty-care centers statewide: 72 to 91 percent of these patients were discharged from such a center, even though there is only one, Children’s Hospital Central California in Madera, serving the entire region.”

According to researchers, the additional reasons for these disparities are likely complex, but the team is planning a follow-up study to determine if HMOs and other private insurers are part of the explanation. Wise hypothesized that “doctors are less likely to refer chronically ill kids with private insurance to pediatric specialty-care centers, whose services generally cost more than those of regular hospitals.”

David Alexander, president and CEO of the Lucile Packard Foundation for Children’s Health and adjunct clinical professor at the medical school, noted that one in eight US children reside in California, making the results of the study, which was also published in Pediatrics, a national concern.

“A greater number of hospital days are being filled by kids with chronic conditions,” Alexander said. “We need to find a way to provide these specialty care services to all children who need them.”