By Dr. Paul Ehrlich
A study that has been attracting a fair amount of coverage in recent days shows that children who lack health insurance and have intermittent asthma are not as likely to receive a confirmed diagnosis of asthma as either those who are insured and those with serious asthma who don’t have insurance.
The reasons are self-evident. Children with insurance have access to regular health care. All the symptoms we associate with asthma are more likely to add up to lead to diagnosis and treatment when there’s a supervising doctor in the picture. For the uninsured, who have no continuity of care, symptoms that occur as random events are unlikely to end up in front of a single physician leading to a diagnosis and a regimen of control and emergency medicine.
As for the uninsured with persistent symptoms, the squeaky wheel gets the grease. The researchers suggest these children, “have a higher level of need for acute asthma care, [and therefore] they tend to present to clinics, urgent care centers, and emergency departments regardless of their insurance status, thus creating similar opportunities for diagnosis.”
One of the researchers, Tumaini Coker, MD, MBA, of the University of California Los Angeles, was quoted to the effect that expanded coverage under the Affordable Care Act would have mixed benefits: “This increase in the proportion of insured children may reduce the number of undiagnosed children with intermittent asthma symptoms and ensure that they receive more appropriate treatment; large cost savings from reduced acute care utilization, however, may not be a realistic expectation.”
I’d like to say this: Dollar costs aren’t the only costs involved. Children may have asthma symptoms only intermittently, but they suffer chronically as their inflamed lungs are remodeling. They miss school, which may well cause their parents to also miss days of work, but when they are there they are often inattentive and disruptive, compromising not just their own education but that of their classmates.
I’m the first to admit that insurance doesn’t guarantee a correct diagnosis of asthma, or effective treatment. Some parents and doctors are reluctant to use the A word, and some doctors find asthma where there isn’t any. Then, too, approximately 50% of patients don’t take their medication as directed anyway. But regardless of their insurance status, they ought to have a chance.