Private Versus Medicaid Patients Referred to Developmental Behavioral Pediatricians: Do They Differ? A DBPNet Study.

Area of Science:

• Pediatric Health
• Developmental Behavioral Pediatrics
• Health Services Research

Background:

• Insurance status is a critical determinant of healthcare access and quality.
• Limited data exists on how insurance affects developmental behavioral pediatric evaluations.
• Understanding these disparities is crucial for equitable care delivery.

Purpose of the Study:

• To compare developmental behavioral pediatric referrals, evaluations, and treatments between children with Medicaid and private insurance.
• To identify potential disparities in care based on insurance type.
• To inform strategies for improving access and outcomes in developmental behavioral pediatrics.

Main Methods:

• A comparative study involving 56 developmental behavioral pediatricians across 12 sites.
• Anonymous data collected on ≤15 consecutive referrals per pediatrician.
• Multivariable models used to analyze sociodemographic factors, referral concerns, evaluation elements, and diagnoses for children with Medicaid (n=309) vs. private insurance (n=393).

Main Results:

• Children with Medicaid showed significant socioeconomic differences (race, parental education, English proficiency).
• Referral sources were similar, with fewer Medicaid patients self-referred.
• Both groups presented with multiple concerns (e.g., speech delays, ASD, ADHD); Medicaid patients had more behavioral concerns.
• Wait times (∼20 weeks) and visit lengths (>2 hours) were similar; few differences in services/recommendations were noted.

Conclusions:

• Care delivery showed few significant differences between insurance groups in developmental behavioral pediatrics.
• Most patients presented with complex needs requiring extensive evaluations.
• Long wait times for appointments represent a significant barrier, potentially impacting therapeutic outcomes for all children regardless of insurance status.