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Medicine Use, Asthma Control, and Perceived Financial Burden by Type of Health Insurance in African American Women With Asthma FREE TO VIEW

Minal Patel, PhD; Kausar Hafeez, MPH; Lara Thomas, MPH; Noreen Clark, PhD
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University of Michigan, Ann Arbor, MI

Chest. 2013;144(4_MeetingAbstracts):540A. doi:10.1378/chest.1702998
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SESSION TITLE: Improving Quality and Reducing Cost

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM

PURPOSE: Health insurance serves as both a marker of access for patients and reimbursement for clinicians, and as a result, may affect clinical recommendations and disease management. The purpose of this study was to examine self-management resources, asthma control and perceived financial burden by health insurance.

METHODS: Baseline data from a randomized control trial were collected through standardized telephone interviews from 343 African American women with persistent asthma seeking services in the University of Michigan Health Care System. Relationships between type of health insurance, self-management resources (spacer, peak flow meter, asthma action plan, negotiated plan, asthma medications), and perceptions of financial burden were examined using chi-square and Fisher’s exact test.

RESULTS: The mean age of participants was 42.8 years (SD=14.82). Participants with government-sponsored insurance had worse asthma control than those with private insurance (X2(2)=26.92, p<0.001). More individuals with private insurance reported owning a spacer (X2(5) = 1.32; p=0.05) and peak flow meter (X2(5) = 3.94; p=0.05) compared to individuals with government-sponsored insurance. No differences were observed between type of insurance and having an asthma action plan or negotiated treatment plan. All participants should be prescribed controller medication, however among those who were not, 19% had private insurance, 11% had Medicare with supplemental coverage, 24% had Medicaid, and 34% had other government sponsored insurance. More people with private insurance perceive financial burden with their asthma management compared to those with government-sponsored insurance (X2(1)=5.02, p=0.05).

CONCLUSIONS: Individuals with government-sponsored insurance have worse asthma and these plans typically have less cost-sharing, especially for essential disease management provisions. However, individuals with private insurance are receiving more disease management recommendations from clinicians, and perceive greater financial burden with their care.

CLINICAL IMPLICATIONS: Providing controller recommendations for both patients with private and government-sponsored insurance plans is indicated. Special attention is needed for patients with government sponsored insurance to address their greater disease burden. Consideration of how to reduce cost sharing associated with the treatment plan is needed for patients with private insurance.

DISCLOSURE: The following authors have nothing to disclose: Minal Patel, Kausar Hafeez, Lara Thomas, Noreen Clark

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