The researchers studied patients at Cincinnati Children’s Hospital Medical Center using several assessments to study factors including disease activity, patient well-being, pain, health care resource utilization and patient insurance status. 295 children who had been seen at least once were included in the study. Fourteen percent of the children had Medicaid status. These patients were more likely to be of a nonwhite race and more frequently had polyarticular JRA or systemic JRA than white patients.
The researchers corrected the data for factors, such as disease duration, race, JRA onset and JRA course, but children with Medicaid status were still more likely to have higher levels of disability and lower health-related quality of life than children with private health insurance, even though both groups had similar health care resource utilization. These children also were less likely to achieve normal physical function.
Children with Medicaid and children with private health insurance had a similar duration of follow-up care, a similar number of visits, and the researchers concluded that children with Medicaid had similar access to health care services as children with private health insurance. However, children with Medicaid were significantly less likely to receive MRIs, were seen more often in the opthamology department and were twice as likely as non-Medicaid patients to have visits to the emergency room.
The researchers theorize that factors other than differences in treatment may account for the differences in quality of life and disability levels between the two groups. Two factors suggested are poverty and nonadherence with prescribed treatments. The researchers acknowledged potential flaws in the study and suggested that further studies are required to provide more information on the causes of the differences between these two groups. They also suggested that further studies should be done to determine whether access to and utilization of health care resources is really equal between patients with varying health insurance status.
Source: Differences in Disease Outcomes Between Medicaid and Privately Insured Children: Possible Health Disparities in Juvenile Rheumatoid Arthritis. Brunner, Hermine, et al. Arthritis Care & Research, Vol 55, No. 3, June 15, 2006.