Parents forgo treatment for children when out-of-pocket prices rise

Studies have shown that uninsured children have less access to health care services. But what about children with insurance that carries expensive out-of-pocket costs? 

That’s what University of Minnesota assistant professor Pinar Karaca-Mandic wanted to learn. She recently completed a study, published in the Journal of the American Medical Association, that looked at children with asthma.

“Of course insurance makes it easier for patients to access health care,” Karaca-Mandic said. “However, there has been a trend to increasing out-of-pocket payments that patients and families make. And studies of adults have shown that people often respond to this by forgoing necessary health care.”

Study results

Pinar Karaca-Mandic

Karaca-Mandic found that children of parents who pay more out-of-pocket costs use their asthma control medication less often and have more asthma-related hospitalizations. 

“We found that among children age 5 to 18 years, children whose families paid more out-of-pocket towards asthma-control medications used their medications less often,” she said. “And, at the same time, these children were more likely to get hospitalized for asthma. We didn’t find this effect for younger children, which perhaps reflects that parents are less sensitive to costs for these younger children whose asthma is typically more severe.”

Karaca-Mandic added that this impacts the overall health care system.

“The result is these children aren’t getting the medicine they need, which can spell serious long-term trouble for them,” she said. “The results signal one of the true impacts of rising insurance costs.” She added that children, families, and schools should be educated on the importance of asthma care and the potential life-long implications of medication under-use.”

About the study

The study is a collaboration led by University of Minnesota health policy researcher Karaca-Mandic. She partnered with researchers from Massachusetts General Hospital and the University of Southern California. The researchers looked at 8,834 privately insured patients from across the United States who were prescribed medication for long-term asthma control. 

The research was funded by the National Institute of Child Health and Human Development, the National Institute on Aging and the Roybal Center for Health Policy Simulation. The study’s co-authors are Anupam B. Jena, M.D., Ph.D., Massachusetts General Hospital, and Geoffrey Joyce, Ph.D., and Dana Goldman, Ph.D., both from the Schaeffer Center for Health Policy and Economics at USC.