Private Versus Medicaid Patients Referred to Developmental Behavioral Pediatricians

Do They Differ? A DBPNet Study

Ruth E. K. Stein, Ellen J. Silver, Marilyn C. Augustyn, Nathan J. Blum, Pamela High, Nancy J. Roizen

Research output: Contribution to journalArticle

Abstract

BACKGROUND: It is unknown how insurance status affects elements of evaluation at developmental behavioral (DB) pediatric sites. OBJECTIVE: To compare DB referrals, evaluation, and treatment for children with Medicaid and private insurance. DESIGN/METHODS: Fifty-six developmental behavioral pediatricians at 12 sites recorded anonymous data on structured forms for ≤15 consecutive referrals. Children with Medicaid (n = 309) and private insurance (n = 393) were compared on sociodemographic factors, referral concerns, evaluation elements, and resulting diagnoses. All significant bivariate findings were verified in multivariable models controlling for site and sociodemographic characteristics. RESULTS: Those with Medicaid were significantly less likely to be white (30% vs 63%) and to have parents who went beyond high school (50% vs 92%) and who spoke English (89% vs 97%) (all p < 0.001). Referral sources were similar, except that fewer children with Medicaid were self-referred (12% vs 22%; p < 0.01). Both groups presented with multiple concerns, ∼3/child, especially speech and language delays, autism spectrum disorder, and attention-deficit hyperactivity disorder. Children with Medicaid tended to present more often with concerns about other behavior problems (14% vs 7%; p = 0.05). Wait times to appointments were similar (∼20 weeks), and visits were over 2 hours in length. Only 1 of 92 services and recommendations differed significantly. CONCLUSION: There were few differences in care, but most DB patients presented with multiple concerns and had complex evaluations. Regardless of the insurance type, they experienced long wait times that may be detrimental to therapeutic outcomes.

Original languageEnglish (US)
Pages (from-to)325-334
Number of pages10
JournalJournal of developmental and behavioral pediatrics : JDBP
Volume39
Issue number4
DOIs
StatePublished - May 1 2018

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Medicaid
Referral and Consultation
Insurance
Language Development Disorders
Insurance Coverage
Attention Deficit Disorder with Hyperactivity
Appointments and Schedules
Parents
Pediatricians
Pediatrics
Therapeutics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Private Versus Medicaid Patients Referred to Developmental Behavioral Pediatricians : Do They Differ? A DBPNet Study. / Stein, Ruth E. K.; Silver, Ellen J.; Augustyn, Marilyn C.; Blum, Nathan J.; High, Pamela; Roizen, Nancy J.

In: Journal of developmental and behavioral pediatrics : JDBP, Vol. 39, No. 4, 01.05.2018, p. 325-334.

Research output: Contribution to journalArticle

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