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Generalists provide the majority of care to Medicaid-insured children with chronic conditions

Medicaid-insured children with chronic diseases receive the majority of their care from generalist physicians, finds a study supported by the Agency for Healthcare Research and Quality (HS09416). Medicaid-insured children who have chronic conditions may find it particularly difficult to gain access to specialists, given their limited resources and barriers to care (for example, lack of transportation and cultural/language differences), as well as the potential unwillingness of specialists to accept Medicaid patients, suggests lead author Karen Kuhlthau, Ph.D., of Massachusetts General Hospital for Children.

Dr. Kuhlthau and colleagues analyzed Medicaid claims data collected from 1989 to 1992 from four States for over 57,000 children and adolescents with 11 chronic conditions to calculate annual rates of generalist, subspecialist, and pediatric subspecialist use. Most children with chronic conditions had visits to generalists: 78 to 90 percent of children with Supplemental Security Income (SSI) and 85 to 94 percent of children without SSI during the year studied. Fewer children visited any relevant subspecialists (24 to 59 percent of children with SSI and 13 to 56 percent of children without SSI) or relevant pediatric subspecialists (10 to 53 percent of children with SSI and 3 to 37 percent of children without SSI).

Among the conditions studied, only children who had spina bifida, seizure disorder, congenital heart disease, or cerebral palsy had more than a 50 percent likelihood of any relevant subspecialty visit in 1 year. Children with asthma, mental retardation, and attention deficit/hyperactivity disorder were least likely to visit a relevant subspecialist, perhaps reflecting primary care doctors' greater comfort with and knowledge about caring for these problems.

More details are in "Who cares for Medicaid-enrolled children with chronic conditions?" by Dr. Kuhlthau, Timothy G. Ferris, M.D., M.P.H., Anne C. Beal, M.D., M.P.H., and others, in the October 2001 Pediatrics 108(4), pp. 906-912.

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