Ian Nathanson ^1*, Gabriela Ramírez-Garnica ¹, Stacey Armatti Wiltrout ¹

¹ Nemours Foundation

^* To whom correspondence should be addressed. E-mail: inathans{at}nemours.org.

	Abstract

Objective: The evolution of managed care (MC) has raised concerns about differential access to care for children with cystic fibrosis (CF). We tested the hypothesis that CF children with MC attended CF Centers less frequently compared to children with non-managed care (NMC). Methods: A prospective cohort study conducted by telephone every four months measured access to care at CF Centers in 630 randomly selected patients aged 6-18 years from 15 US CF Centers. Data analysis used unconditional logistic regression and generalized estimating equations. Results: Attending CF Centers was significantly reduced in children with MC (OR=0.74, 95% CI=0.57-0.98; p=0.03) and in females (OR=0.68; 95% CI=0.48-0.97; p=0.04). Conclusions: CF children with MC attended CF Centers significantly less frequently than those with NMC. These findings suggest that CF children with MC may not have equal access to experts in CF as children with NMC. Families should consider this when selecting their medical insurance plan. These findings may apply to other children with special health care needs.

Key Words: Child and Adolescent Health, Chronic Disease, Managed Care, Access to Care, Respiratory Health