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Trends in Private Insurance, Medicaid/State Children’s Health Insurance Program, and the Health-Care Safety Net^*

Implications for Asthma Disparities

^* From the Institute for Health Policy, Partners Healthcare, and Harvard Medical School, Harvard University, Cambridge, MA.

Correspondence to: Alexandra E. Shields, PhD, Massachusetts General Hospital/Partners HealthCare, Institute for Health Policy, 50 Staniford St, 9th Floor, Suite 901, Boston, MA 02114; e-mail: ashields{at}partners.org

Disparities in asthma prevalence, severity, quality of care, and outcomes have been widely documented across racial/ethnic communities, among privately insured vs publicly insured patients, and according to patients’ socioeconomic status, among other patient characteristics. In order to effectively address asthma disparities, changes will need to be made across all systems of care in which these subpopulations receive health-care services. The majority of current trends in private insurance, Medicaid/State Children’s Health Insurance Program, and the safety net are likely to further exacerbate asthma disparities rather than help to reduce these disparities. Asthma cannot be effectively managed unless individuals have affordable access to a full range of services and receive coordinated, quality health care. Multiple policy levers will need to be simultaneously employed to ensure access to the full range of services needed for effective asthma management, especially among low-income and minority persons with asthma in order to reduce the gap in disparities. The needs of these patients must be thoughtfully addressed and strategically advocated for within all systems of care in which these subpopulations receive health services. This overall strategy must necessarily include consideration of the capacity of safety-net providers to meet the needs of uninsured and underinsured persons with asthma. This article reviews trends in health-care financing, in clinical management, and the health-care safety net, and assesses their likely impact on asthma disparities. It concludes with a discussion of key policy arenas that will have significant influence on the eventual success of efforts to reduce asthma disparities.

Key Words: asthma • disparities • health policy • Medicare • private insurance • uninsured

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