Essays on Physician Incentives and Pharmaceutical Outcomes in Asthmatic Children.

Asthma;Child;Pharmaceutical Outcomes;Pediatrics;Health Sciences;Social & Administrative Sciences

Chang, JongwhaProsser, Lisa ;

University of Michigan

关键词: Asthma;    Child;    Pharmaceutical Outcomes;    Pediatrics;    Health Sciences;    Social & Administrative Sciences;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/91588/jochang_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

It is believed that health plans, reimbursement mechanisms and financial incentives led to health outcomes for health care utilization and medication adherence from pediatric populations. However, there is little empirical evidence about the effect of health plans, reimbursement mechanisms and financial incentives on asthmatic pediatric population. The first study examined how sociological factors including financial incentives influenced whether asthmatic children received a controller medication, a reliever medication or both. The 2007 National Ambulatory Medical Care Survey was used for this analysis. Compared with physicians who received lower financial incentives, physicians who received medium (39%, p<0.05) or higher (42%, p<0.01) financial incentives from payers were more likely to prescribe controller medication than reliever medication for children with asthma.The second study examined associations between the type of health plan (fee for service vs. capitated) and utilization-based outcomes in asthmatic Medicaid children. Subjects were 6435 Medicaid enrolled asthmatic children who newly started asthma pharmacotherapy and were followed 12 months before and 12 month after the index anti-asthmatic medication. Patient in capitated plans were associated with 77% more hospitalizations and 34% increased incidence rates of emergency department visits, but 42% fewer outpatient visits compared to those in FFS plans (all p<0.05).The third study examined the impact of the type of health plan (public vs. private) on health outcomes in pediatric asthmatic enrollees. Subjects were 11,027 asthmatic children (6,435 in Medicaid and 4,592 in a commercial HMO) who newly started asthma pharmacotherapy and were followed 12 months before after the index anti-asthmatic medication fill. Patients in Medicaid plans were also associated with 20% more inpatient hospitalizations and 50% increased odds of emergency department visits, but had 42% fewer outpatient visits compared to those in private plan (all p<0.05).In sum, the results of this study provide an insight to clinicians, policymakers and health service researchers in evaluating policies related to insurance coverage of essential medications in indigent children with asthma. This, in turn, could help understand important factors that impact health care financing, design strategies to improve asthma related care, and improve health outcomes for needy and poor children in the United States.