Abstract
BackgroundThe current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral. Our objective was to review the literature on the effects of insurance status on children's access to specialty care.MethodsWe conducted a systematic review of original research published between January 1, 1992 and July 31, 2006. Searches were performed using Pubmed.ResultsOf 30 articles identified, the majority use number of specialty visits or referrals to measure access. Uninsured children have poorer access to specialty care than insured children. Children with public coverage have better access to specialty care than uninsured children, but poorer access compared to privately insured children. Findings on the effects of managed care are mixed.ConclusionInsurance coverage is clearly an important factor in children's access to specialty care. However, we cannot determine the structure of insurance that leads to the best use of appropriate, quality care by children. Research about specific characteristics of health plans and effects on health outcomes is needed to determine a structure of insurance coverage that provides optimal access to specialty care for children.
Highlights
The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care
Access to pediatric specialty care has become a concern in the United States
While much of this concern stems from a known maldistribution and assumed shortage of these providers [1], insurance status is another important determinant of access
Summary
The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Access to pediatric specialty care has become a concern in the United States While much of this concern stems from a known maldistribution and assumed shortage of these providers [1], insurance status is another important determinant of access. BMC Health Services Research 2007, 7:194 http://www.biomedcentral.com/1472-6963/7/194 private insurance are struggling, as employers turn to lower-cost plans with reduced benefits and increased costsharing, require greater employee contributions to premiums, for family coverage, or offer catastrophic-only coverage [4]. These changes in the availability and benefit structures of health insurance could detrimentally affect access to specialty care. Other studies found that managed care enrollees receive more referrals from their primary care physician than other adults [6] and that removal of gatekeeping mechanisms does not increase use of specialty care [7]
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