Correlates of Use of Specialty Care

Abstract

ABSTRACT.Objective. This study examines patterns of specialist use among children and adolescents by presence of a chronic condition or disability, insurance, and sociodemographic characteristics.Design. Cross-sectional analysis of national survey data, describing rates of specialist use, with logistic regressions to examine associations with having a chronic condition or disability, insurance status, and sociodemographic variables.Setting. The 1999 National Health Interview Survey, a nationally representative household survey.Participants. Children and adolescents 2 to 17 years old.Outcome. Parental/respondent reports of specialist visits based on reports of the child having seen or talked to a medical doctor who specializes in a particular medical disease or problem about the child's health during the last 12 months.Results. Thirteen percent of US children were reported as seeing a specialist in the past year. Specialistvisit rates were twice as high for children with a chronic condition or disability (26% vs 10.2%). The specialist utilization rates for children without insurance were much lower than those for insured children, but among the children who have coverage (private, Medicaid, or other), specialist-utilization rates were similar (no statistically significant difference).Results of multivariate analyses predicting the use of specialists confirm the above-mentioned findings. Additionally, they show that use of specialist care was lower among children in the middle age group, minorities, children in families between 100% and 200% of the federal poverty level, and lower parental educational levels. We found no difference in specialist-visit rates between rural-and urban-dwelling children, by family status, or by gender. Differences in specialist use by gatekeeping status are found only among subgroups.Conclusions. The results showed that, overall, 13% of children used a specialist in a year. Among the insured, a slightly greater percentage of children used such care (15%). These numbers were slightly lower than the 18% to 28% of pediatric patients referred per year in 5 US health plans, although the sources of data and definitions of specialist use differ. Our results showed that 26% of children with a chronic condition or disability who were insured by Medicaid use a specialist. Although the data are not directly comparable, this is within the range of previous findings showing annual rates by condition of use between 24% and 59%. These findings are consistent also with greater use of many different types of health care by children with special health care needs.Medicaid-utilization rates presented here were similar also to the rates found among privately insured children and children with "other" insurance. In our earlier work examining use of specialists by children insured by Medicaid, we speculated that Medicaid-insured children might face particular difficulty with access (eg, due to transportation or language barriers). The findings presented here suggest that children insured by Medicaid had no ...

Supply and Utilization of Pediatric Subspecialists in the United States

“…Our findings are consistent with similarly decreased perceived need for subspecialty care among CSHCN in rural compared with urban areas, 22 although previous work examining subspecialty utilization by rural-urban status has shown mixed results. 23,37 Despite these differences in perceived need and utilization, we observed no large differences in child or family disease burden. Given that there are no pediatric subspecialists in most of the lowest PSSQ counties, our results suggest that many children travel outside of their county for subspecialty care, but surprisingly, families in the lowest PSSQ did not report more financial burden and were less likely to report impact on work.…”

“…5,[22][23][24][25][26][27] We controlled for 13 medical conditions or groups of conditions. Down syndrome, developmental delay, muscular dystrophy, and intellectual disability were grouped as "developmental diagnoses."…”

Pursuing Equity: Contact With Primary Care and Specialist Clinicians by Demographics, Insurance, and Health Status

“…Pediatrician specialty and generalist roles were also susceptible to misclassifi cation, though use of specialists by children in the MEPS is consistent with data from other sources. 47,48 Second, advanced-practice nurses could not be separated from other nurses; as discussed previously, the result is a 20% to 25% overestimate of nurse-practitioner ambulatory visits. Third, only ambulatory visits were examined.…”

Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

“…4 Specialty care use also varies, with lower rates of use among minorities, uninsured children, those with less than high school-educated parents, and children in low-income households regardless of insurance type. 1,[4][5][6][7] In addition, low-income families and less educated families report less perceived need for specialist visits even though they report their children have more severe functional limitations than higher-income parents. 8 Among CSHCN, care coordination has been identified as a potential mechanism to decrease unmet specialty care needs.…”