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AJPH First Look, published online ahead of print Sep 29, 2005
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AJPH.2004.059089v1
95/11/1958    most recent
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November 2005, Vol 95, No. 11 | American Journal of Public Health 1958-1963
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.059089

RESEARCH AND PRACTICE

Decreased Attendance at Cystic Fibrosis Centers by Children Covered by Managed Care Insurance

Ian Nathanson, MD, Gabriela Ramírez-Garnica, PhD, MPH and Stacey Armatti Wiltrout, MA, MS

The authors are with the Nemours Clinical Management Program, Orlando, FL.

Correspondence: Requests for reprints should be sent to Ian Nathanson, MD, Nemours Clinical Management Program, 496 South Delaney Avenue, Orlando, FL 32801 (e-mail: inathans{at}nemours.org).

Objective. The evolution of managed care has raised concerns about differential access to care for children with cystic fibrosis (CF). We tested the hypothesis that children with CF with managed care attended CF centers less frequently compared with children with non-managed care.

Methods. We conducted a prospective cohort study by telephone every 4 months to measure access to care at CF centers among 630 randomly selected patients aged 6–18 years from 15 US CF centers. We analyzed data with unconditional logistic regression and generalized estimating equations.

Results. Attendance at CF centers was significantly reduced among children with managed care (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.57, 0.98; P=0.03) and among girls (OR=0.68; 95% CI=0.48, 0.97; P=0.04).

Conclusions. Children with CF with managed care attended CF centers significantly less frequently than those with non-managed care. These findings suggest that children with CF with managed care may not have equal access to experts in CF as children with non-managed care. Families should consider this when selecting their medical insurance plan. These findings may apply to other children with special health care needs.






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