Children’s Receipt of Health Care Services and Family Health Insurance Patterns

Jennifer E. DeVoe; Carrie J. Tillotson; Lorraine S. Wallace

doi:10.1370/afm.1040

Published eLetters

If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

What code is in the image? *

Enter the characters shown in the image.

Vertical Tabs

Jump to comment:

Health Care Reform Should Consider the Same Health Plan for Children and their Parents
Sylvia Guendelman

Published on: 13 October 2009
Covering Entire Families is Better for Both Children and Adults
Benjamin D. Sommers, M.D., Ph.D.

Published on: 18 September 2009

Published on: (13 October 2009)
Page navigation anchor for Health Care Reform Should Consider the Same Health Plan for Children and their Parents
Health Care Reform Should Consider the Same Health Plan for Children and their Parents
Sylvia Guendelman, Berkeley, California
The study by DeVoe, Tilltson and Wallace in the Sept/October 2009 issue of Annals of Family Medicine confirms our previous findings at both the national and California state level on the importance of providing health insurance to both parents and children of the working poor and expands the reach by examining nationally representative data for all income children ages 2 to 17 years.
Our secondary data analyses o...
Show More

The study by DeVoe, Tilltson and Wallace in the Sept/October 2009 issue of Annals of Family Medicine confirms our previous findings at both the national and California state level on the importance of providing health insurance to both parents and children of the working poor and expands the reach by examining nationally representative data for all income children ages 2 to 17 years.
Our secondary data analyses of the 2000 National Health Interview Survey found that among working poor families with incomes at or below 200 percent of federal poverty level, children with no family coverage encountered more barriers to care than children with child-only or family coverage. Once the child was covered, it appeared that extending coverage to parents and children confered a greater ability to avoid breaks in coverage and to obtain regular care in a doctor's visit or HMO.(1) Similarly, our analysis of the California Health Interview Survey for 2001 found that among the working poor, children with child-only coverage were more likely than those with family coverage to experience breaks in coverage, to lack a usual source of care and to report feelings of discrimination when receiving care. However, service utilization was comparable.(2)
Devoe et al.'s study is timely given current attempts to overhaul our health insurance and health care delivery systems, and recent Congressional approval in January 2009 to fund CHIP for another 10 years. Despite attempts in some states such as California to expand CHIP to include uninsured children and their parents, current Congressional efforts moved towards offering subsidies to individuals seeking to purchase coverage within an Insurance Exchange gateway.
Health care reform is likely to keep CHIP while health insurance Exchanges get established and make coverage affordable to the poor. In the meantime, it is of the essence that we remind policymakers of the benefits of streamlining health insurance so that children and their parents can navigate through the same health plans.
1. Guendelman S. and Pearl M. Children's ability to access and use health care. Health Affairs, 2004;23:235-244. 2. Guendelman S , Weir M, Angulo V and Oman D. The effects of child-only insurance coverage and family coverage on health care access and use: Recent findings among low-income children in California. Health Services Research, 2006;41:125-147.
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (18 September 2009)
Page navigation anchor for Covering Entire Families is Better for Both Children and Adults
Covering Entire Families is Better for Both Children and Adults
Benjamin D. Sommers, M.D., Ph.D., Boston, MA
In the current issue of Annals of Family Medicine, DeVoe, Tillotson, and Wallace (2009) add to the growing body of evidence that a patchwork approach to health insurance coverage puts at risk children’s access to care. In their study, children with health insurance but whose parents were uninsured were less likely to have a usual source of care or receive preventive services, compared to children whose parents were insu...
Show More

In the current issue of Annals of Family Medicine, DeVoe, Tillotson, and Wallace (2009) add to the growing body of evidence that a patchwork approach to health insurance coverage puts at risk children’s access to care. In their study, children with health insurance but whose parents were uninsured were less likely to have a usual source of care or receive preventive services, compared to children whose parents were insured.

In some of my research in this area, I found that children in Medicaid are more likely to drop out and become uninsured if their parents are not in Medicaid (Sommers, 2006), and states that run separate Medicaid and CHIP programs have worse drop-out rates than states with single combined programs (Sommers, 2005). Both of these issues point to the harms caused by the fragmentation of health coverage. Under the current system, a family may have one child in Medicaid, another in CHIP, and adults either in private insurance or uninsured. It is hardly surprising that many fall through the cracks, losing coverage over time or failing to utilize their coverage for needed preventive services.

Devoe et al.’s study, along with the body of literature they cite, forms a convincing collection of research to suggest that we need to shift our focus from covering individuals to covering families – whether through public or private insurance. As the debate on comprehensive health reform continues, it is important that policymakers heed the findings of studies like this one. If we want to keep children and adults insured and make sure that coverage produces real gains in health care access, we need to minimize fragmentation by covering entire families in the same health plans.

REFERENCES
DeVoe JE, Tillotson CJ, Wallace LS. Children’s Receipt of Health Care Services and Family Health Insurance Patterns. Annals of Family Medicine. 2009; 7: 406-413.

Sommers BD. The Impact of Program Structure on Children’s Disenrollment From Medicaid & SCHIP. Health Affairs. 2005; 24(6): 1611-1618.

Sommers BD. Insuring Children or Insuring Families: Do Parental and Sibling Coverage Lead to Improved Retention of Children in Medicaid? Journal of Health Economics. 2006; 25(6): 1154-1169.
Competing interests: None declared
Show Less

Competing Interests: None declared.