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Healthcare utilization by children with asthma displaced by Hurricane Katrina
1a College of Public Health , University of South Florida , Tampa , FL , USA.
Insights
The TexKat (Hurricane Katrina Medicaid Emergency Waiver) program largely prevented healthcare disruptions for asthmatic children post-disaster. However, analysis suggests potential underutilization of controller medications and visits, indicating possible inadequate care.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Healthcare
Background:
- Hurricane Katrina significantly impacted healthcare access for vulnerable populations.
- Medicaid Emergency Waivers were implemented to mitigate these disruptions.
- Asthmatic children represent a population with specific ongoing healthcare needs.
Purpose of the Study:
- To evaluate the performance of the Texas Children's Health Insurance Program (TexKat), a large Hurricane Katrina Medicaid Emergency Waiver.
- To assess the impact of TexKat on healthcare utilization for asthmatic children post-disaster.
- To compare healthcare access changes in TexKat enrollees with control groups.
Main Methods:
- A pre-post comparison design using Medicaid enrollment and encounter data from Louisiana and Texas for 2004 and 2006.
- Analysis of prescription data for controller and quick-relief asthma medications.
- Comparison of healthcare utilization (inpatient, emergency, outpatient, office visits) between TexKat enrollees and three control groups.
Main Results:
- The proportion of TexKat enrollees filling controller medication prescriptions decreased from 0.37 to 0.28 (2004-2006).
- Control groups showed stable or increased proportions for controller medication use.
- Significant decreases in office and emergency department visits were observed in the TexKat group compared to controls (p < 0.001).
Conclusions:
- TexKat was largely successful in preventing extreme disruptions in healthcare utilization for asthmatic children.
- Despite preventing extreme disruptions, the data suggest potential under-treatment or inadequate care for children in the TexKat program.
- Further investigation into care quality and medication adherence is warranted.
Objective:
To assess the performance of TexKat, the largest Hurricane Katrina Medicaid Emergency Waiver, in providing care to asthmatic children.
Methods:
Medicaid enrollment and encounter data for 2004 and 2006 from Louisiana and Texas were analyzed in a pre-post comparison. Changes in utilization by children in the waiver were compared to changes in utilization by children in Medicaid in three control groups: children in Louisiana counties that were designated as a disaster assistance area but who were not displaced; children in Louisiana counties that were not designated as a disaster assistance area, and children in Texas. The analysis included prescriptions for controller and quick-relief medications as well as encounters in inpatient, emergency, outpatient, and office settings.
Results:
The sample proportion of TexKat enrollees who had a prescription filled for controller medications fell from 0.37 to 0.28 between 2004 and 2006. By contrast, the sample proportions for the three control groups were relatively unchanged or increased. The inferential analysis indicated that the 2004-2006 change in proportions for the TexKat group differed from the changes for each of the three control groups (p-value < 0.001). For office and emergency department visits, the 2004-2006 decreases in both the proportion of subjects with a visit and the average number of visits for the TexKat group were greater than the changes for the control groups (p-value < 0.001).
Conclusions:
While TexKat appears to have largely been successful in preventing extreme utilization disruptions, the analysis suggests that children in the program may have received inadequate care.
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