The reasons for the discrepancy are likely complex, the researchers said. But Wise, the Richard E. Behrman Professor of Child Health and Society at the School of Medicine and a pediatrician at Packard Children's, said he and his colleagues were planning to conduct a follow-up study to determine whether health maintenance organizations and other private insurers contributed to this disparity. It's possible, he said, that doctors are less likely to refer chronically ill kids with private insurance to pediatric specialty-care centers, whose services generally cost more than those of regular hospitals.
The study also suggests that the state has been successful in helping low-income children with chronic illnesses get access to specialty-care services. However, the fact that public insurance is paying for the majority of these services makes the pediatric specialty-care centers, not to mention the children who depend on them, especially vulnerable to the state's current financial problems, said the lead author Lisa Chamberlain, MD, MPH, a pediatrician at Packard Children's and assistant professor of pediatrics at the medical school.
"The specialty centers that see these patients are very dependent on the public financing of care," Chamberlain said. "With the unprecedented state budget crisis, Sacramento may look to balance the books by changing reimbursement patterns."
How far chronically ill children lived from specialty-care centers also played a role in determining whether they would be hospitalized at one, but geography wasn't the only important factor, the researchers said, pointing to several counterintuitive findings. One is that chronically ill children in central California the counties of Mariposa, Madera, Fresno and Kings, which are among the poorest in the state were among the most frequent u
|Contact: John Sanford|
Stanford University Medical Center