Childhood Asthma: Higher Out-of-Pocket Costs May Cause Some Parents to Avoid Care

dr_vicki_fung Interview with:
Vicki Fung, Ph.D.
Assistant Professor
Department of Medicine, Harvard Medical School
Mongan Institute for Health Policy, Massachusetts General Hospital


MedicalResearch: What are the main findings of the study?

Dr. Fung: We found that lower income parents of children with asthma were more likely to delay or avoid taking their children to a doctor’s office visit or to the emergency room if they had to pay higher out-of-pocket costs for care; they were also more likely to report borrowing money to pay for asthma care.

MedicalResearch: Were any of the findings unexpected?

Dr. Fung: It is well-known that higher patient cost-sharing is associated with reductions in use of medical services, especially among adults with chronic conditions; however, less is known about the effects of cost-sharing among children and how responses to cost-sharing vary across income levels. In general, the findings of this study were consistent with our hypotheses that financial barriers to care would be concentrated among children with lower household incomes and higher cost-sharing levels. These findings have important policy implications, especially regarding the provision of coverage and subsidies to low income populations, such as those included in the Affordable Care Act (ACA). We specifically designed our study to compare responses to cost-sharing for families with incomes above and below 250% of the Federal Poverty Level, which is the income cut off for low income cost-sharing subsidies mandated by the ACA.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Fung: The ACA includes subsidies that reduce out-of-pocket costs for low income families, which could make health care more affordable, especially for families with children with chronic conditions, such as asthma. These subsidies could reduce financial barriers to care for many low income children and hopefully improve poor outcomes associated with forgone care. Nevertheless, it will continue to be important to incorporate discussions about costs into clinical encounters, especially when assessing potential barriers to care, even for those with insurance coverage.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Fung: While the subsidies included in the ACA are a promising step for improving coverage and access for many low income children, there are also rules that exclude many low income families from receiving these subsidies and open questions about whether the amount of the subsidy is sufficient to reduce cost-related barriers to care. It will be important to monitor and evaluate the effects of these policies on low income families and children now that the implementation of the ACA is in full swing.


Last Updated on May 21, 2014 by Marie Benz MD FAAD