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

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Table 1.

Cross-Sectional Family Health Insurance Coverage Patterns for US Children (Aged 2–17 Years) Living With at Least 1 Parent, 2002–2006

Coverage Patterns	2002–2006 Unweighted N^a	2002–2006 Yearly Average Weighted to US Population^b(in millions)	2002–2006 Weighted %^b(95% CI)
Source: 2002–2006 Medical Expenditure Panel Survey (MEPS), Household Component (HC), Agency for Healthcare Research and Quality, Rockville, Maryland.
CI=confidence interval.
^a Unweighted counts at the child level represent the total number of children, aged 2–17 years, from MEPS respondent households with a positive person weight who could be linked to at least 1 parent within the household. Total counts do not include the 1,737 children with no parent in the household. An additional 73 children were excluded because self or parental insurance coverage status could not be ascertained on December 31 of the given year (total exclusions = 1,810). Unweighted national statistics exclude the 1,372 individuals for whom insurance coverage status could not be ascertained on December 31 of the given year.
^b To derive the yearly population estimates, each record from the MEPS was weighted according to person-level weights provided by the data-collection agency for use in pooling multiple years.
^c In 2-parent families, both parents had insurance coverage on December 31 of the given year; in single-parent families, the sole parent had insurance coverage on December 31 of the given year.
^d In 2-parent families, 1 parent had coverage and the other parent did not have insurance coverage on December 31 of the given year.
^e In 2-parent families, both parents did not have insurance coverage on December 31 of the given year; in single-parent families, the sole parent did not have insurance coverage on December 31 of the given year.
Cross-sectional family patterns at the child level (insurance status on December 31)
Child insured, parents insured c	27,804	46.9	73.6 (72.4–74.7)
Child insured, 1 parent insured, 1 parent uninsured d	2,934	3.1	4.8 (4.4–5.2)
Child insured, parents uninsured^e	6,574	6.4	10.0 (9.4–10.7)
Child uninsured, parents insured c	835	1.2	1.9 (1.7–2.2)
Child uninsured, 1 parent insured, 1 parent uninsured^d	863	1.1	1.7 (1.5–2.0)
Child uninsured, parents uninsured e	4,499	5.1	8.0 (7.4–8.6)
Total	43,509	63.8	100
Cross-sectional national statistics for US population (insurance status on December 31)
Insured	131,819	241.3	82.9 (82.4–83.5)
Uninsured	34,542	49.6	17.1 (16.5–17.7)
Total	166,361	290.9	100

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Table 2.

Multivariate Associations Between Child and Family Characteristics and Children’s Access to Health Care (2002–2006)

Demographic and Other Characteristics	Child Coverage Gap^a OR (95% CI)	No Usual Source of Care OR (95% CI)	No Doctor Visit in Past 12 Months OR (95% CI)	Child Visits Dentist Less Than 1/yr OR (95% CI)	Any Unmet Health Care Need^bOR (95% CI)
Source: 2002–2006 Medical Expenditure Panel Survey (MEPS), Household Component (HC), Agency for Healthcare Research and Quality, Rockville, Maryland.
CI=confidence interval; FPL = federal poverty level; OR = odds ratio.
^a All children uninsured on December 31 had a coverage gap, so adjusted odds ratio was reported only for the children insured on December 31 who had a coverage gap at some other point during the year.
^b Child had at least 1 of the following 16 unmet needs in the past 12-months: did not get needed care right away, no visits to the doctor’s office, problem in getting needed care, problem in getting specialty care, unable to get needed medical care, problem in not getting needed care, delayed in getting medical care, problem in getting delayed medical care, unable to get needed dental care, problem in not getting needed dental care, delayed in getting dental care, problem in getting delayed dental care, unable to get needed prescription medication, problem in not getting prescription medication, delayed prescription care, problem in delay of getting prescription medication.
^c In 2-parent families, both parents had insurance coverage on December 31 of the given year; in single-parent families, the sole parent had insurance coverage on December 31 of the given year.
^d In 2-parent families, 1 parent had coverage and the other parent did not have insurance coverage on December 31 of the given year.
^e In 2-parent families, both parents did not have insurance coverage on December 31 of the given year; in single-parent families, the sole parent did not have insurance coverage on December 31 of the given year.
^f The household income groups were based on the MEPS-HC constructed variable that divides families into 5 income groups based on earnings as a percentage of the FPL: poor (<100% FPL); near poor (100% to <125% FPL); low income (125% to <200% FPL); middle income (200% to <400% FPL); and high income (>400% FPL). In 2006, the federal poverty level for a family of 4 was $20,000.
^g Child’s race/ethnicity was self-determined by parent respondents based on standard options provided by MEPS interviewers. One combined child race/ethnicity variable was created by combining a race variable—which included white only, black only, American Indian/Alaskan Native only, Asian only, native Hawaiian/Pacific Islander only, and multiple races—and an ethnicity variable—which included Hispanic, or not Hispanic.
^h Family composition refers to whether the child could be linked to 1 parent or 2 parents residing in the same household (it does not account for biological relationship between parent and child or the marriage status between the 2 parents).
Family insurance patterns
Child insured, parents insured^c (reference group)	1.00	1.00	1.00	1.00	1.00
Child insured, parents 1 insured, 1 uninsured^d	2.26 (1.79–2.85)	1.34 (0.99–1.81)	1.18 (1.01–1.37)	1.39 (1.16–1.66)	1.09 (0.96–1.23)
Child insured, parents uninsured^e	2.45 (2.02–2.97)	1.31 (1.10–1.56)	1.10 (1.00–1.22)	1.13 (0.97–1.30)	1.11 (1.01–1.22)
Child uninsured, parents insured^c	NA	1.87 (1.46–2.40)	1.45 (1.16–1.79)	1.80 (1.39–2.32)	1.29 (1.05–1.59)
Child uninsured, parents 1 insured, 1 uninsured^d	NA	2.89 (2.13–3.92)	1.68 (1.33–2.14)	2.83 (2.21–3.61)	1.49 (1.20–1.84)
Child uninsured, parents uninsured^e	NA	4.30 (3.65–5.06)	2.17 (1.94–2.44)	2.96 (2.55–3.43)	1.93 (1.73–2.15)
Household income groups^f
High income (reference group)	1.00	1.00	1.00	1.00	1.00
Middle income	2.21 (1.72–2.84)	1.46 (1.21–1.76)	1.74 (1.57–1.93)	1.84 (1.62–2.09)	1.58 (1.45–1.73)
Low income	3.01 (2.32–3.90)	1.57 (1.27–1.94)	1.99 (1.74–2.27)	2.41 (2.06–2.82)	1.83 (1.65–2.04)
Near poor	3.42 (2.47–4.74)	1.77 (1.38–2.26)	2.27 (1.94–2.65)	2.39 (1.95–2.93)	1.99 (1.74–2.28)
Poor/negative	2.62 (1.96–3.50)	1.60 (1.29–1.99)	2.20 (1.93–2.51)	2.35 (1.98–2.78)	1.96 (1.75–2.20)
Child’s age, years
2–4 (reference group)	1.00	1.00	1.00	1.00	1.00
5–9	1.03 (0.90–1.17)	1.42 (1.24–1.63)	2.07 (1.85–2.31)	0.18 (0.16–0.20)	1.52 (1.40–1.66)
10–13	1.11 (0.94–1.30)	1.88 (1.61–2.19)	2.51 (2.24–2.82)	0.17 (0.15–0.19)	1.69 (1.54–1.85)
14–17	1.06 (0.91–1.24)	2.85 (2.40–3.38)	2.87 (2.55–3.22)	0.27 (0.24–0.31)	2.00 (1.82–2.20)
Child’s race/ethnicity^g
White, non-Hispanic (reference group)	1.00	1.00	1.00	1.00	1.00
Hispanic, any race	1.32 (1.10–1.59)	1.73 (1.43–2.10)	1.37 (1.23–1.53)	1.11 (0.97–1.26)	1.10 (1.00–1.20)
Nonwhite, non-Hispanic	0.95 (0.78–1.15)	1.59 (1.32–1.93)	1.48 (1.33–1.64)	1.06 (0.95–1.18)	1.14 (1.05–1.24)
Family composition^h
2 parents in household (reference group)	1.00	1.00	1.00	1.00	1.00
1 parent in household	1.23 (1.05–1.44)	1.09 (0.93–1.27)	0.95 (0.88–1.03)	1.16 (1.03–1.26)	1.06 (0.98–1.14)
At least 1 parent completed high school
Yes (reference group)	1.00	1.00	1.00	1.00	1.00
No	1.07 (0.91–1.26)	1.40 (1.23–1.60)	1.39 (1.26–1.54)	1.42 (1.25–1.60)	1.17 (1.06–1.29)
At least 1 parent employed
Not currently employed (reference group)	1.00	1.00	1.00	1.00	1.00
Employed/self-employed	0.83 (0.68–1.02)	0.86 (0.73–1.01)	1.26 (1.12–1.42)	1.04 (0.89–1.22)	1.12 (1.02–1.24)
Geographic residence
Northeast (reference group)	1.00	1.00	1.00	1.00	1.00
West	1.46 (1.13–1.88)	2.93 (2.19–3.91)	2.29 (1.92–2.72)	1.39 (1.17–1.66)	1.97 (1.73–2.25)
South	1.44 (1.13–1.83)	2.89 (2.22–3.77)	1.70 (1.44–2.01)	1.42 (1.22–1.66)	1.58 (1.40–1.78)
Midwest	1.16 (0.90–1.49)	1.93 (1.43–2.61)	1.69 (1.41–2.03)	1.24 (1.04–1.48)	1.46 (1.28–1.67)
Child health status
Excellent (reference group)	1.00	1.00	1.00	1.00	1.00
Not excellent	0.99 (0.89–1.11)	0.93 (0.83–1.04)	0.71 (0.66–0.76)	1.19 (1.10–1.29)	1.10 (1.04–1.17)

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Table 3.

Multivariate Associations Between Child and Family Characteristics and Children’s Receipt of Preventive Health Counseling (2002–2006)

Demographic and Other Characteristics	Missing at Least 1 of 4 Preventive Counseling Items in Past 2 Years^aOR (95% CI)	Missing All 4 Preventive Counseling Items In Past 2 Years^aOR (95% CI)	Never Had At Least 1 of 4 Preventive Counseling Items^aOR (95% CI)	Never Had All 4 Preventive Counseling Items^aOR (95% CI)
Source: 2002–2006 Medical Expenditure Panel Survey (MEPS), Household Component (HC), Agency for Healthcare Research and Quality, Rockville, Maryland.
CI=confidence interval; OR = odds ratio.
Note: To derive the yearly population estimates, each child record from the MEPS was weighted according to person-level weights provided by the data-collection agency for use in pooling multiple years.
^a The preventive counseling services include MEPS-HC items that asked parents whether a doctor or health provider had advised their child about the importance of (1) healthy eating, (2) routine exercise, (3) use of car safety seats/booster seats/seat belts, and (4) use of a helmet while riding a tricycle/bicycle.
^b In 2-parent families, both parents had insurance coverage on December 31 of the given year; in single-parent families, the sole parent had insurance coverage on December 31 of the given year.
^c In 2-parent families, 1 parent had coverage and the other parent did not have insurance coverage on December 31 of the given year.
^d In 2-parent families, both parents did not have insurance coverage on December 31 of the given year; in single-parent families, the sole parent did not have insurance coverage on December 31 of the given year.
^e For information regarding household income groups, see footnote to Table 2.
^f For information regarding child’s race/ethnicity, see footnote to Table 2.
^g For information regarding family composition, see footnote to Table 2.
Family insurance patterns
Child insured, parents insured (reference group)^b	1.00	1.00	1.00	1.00
Child insured, parents 1 insured, 1 uninsured^c	1.26 (1.04–1.53)	1.07 (0.93–1.24)	1.33 (1.11–1.60)	1.08 (0.93–1.26)
Child insured, parents uninsured^d	1.16 (0.99–1.36)	1.10 (0.99–1.21)	1.20 (1.04–1.39)	1.10 (1.01–1.21)
Child uninsured, parents insured^b	1.33 (0.93–1.91)	1.40 (1.11–1.76)	1.32 (0.96–1.82)	1.38 (1.08–1.75)
Child uninsured, parents 1 insured, 1 uninsured^c	1.33 (0.88–2.02)	1.42 (1.12–1.81)	1.41 (0.97–2.05)	1.37 (1.07–1.76)
Child uninsured, parents uninsured^d	1.67 (1.41–1.98)	1.63 (1.45–1.84)	1.60 (1.35–1.90)	1.48 (1.31–1.67)
Household income groups^e
High income (reference group)	1.00	1.00	1.00	1.00
Middle income	1.29 (1.13–1.47)	1.44 (1.31–1.59)	1.23 (1.09–1.39)	1.45 (1.31–1.61)
Low income	1.25 (1.07–1.46)	1.46 (1.29–1.65)	1.32 (1.14–1.52)	1.53 (1.35–1.74)
Near poor	1.31 (1.05–1.63)	1.56 (1.32–1.84)	1.32 (1.08–1.60)	1.63 (1.39–1.92)
Poor/negative	1.13 (0.95–1.35)	1.40 (1.24–1.58)	1.15 (0.97–1.35)	1.50 (1.33–1.69)
Child’s age, years
0–4 (reference group)	1.00	1.00	1.00	1.00
5–9	0.87 (0.79–0.97)	1.59 (1.47–1.73)	0.76 (0.69–0.84)	1.43 (1.32–1.56)
10–14	1.03 (0.91–1.17)	2.02 (1.84–2.21)	0.84 (0.74–0.94)	1.75 (1.60–1.92)
15–18	1.48 (1.31–1.67)	2.53 (2.28–2.80)	1.11 (0.99–1.25)	2.03 (1.81–2.26)
Child’s race/ethnicity^f
White, non-Hispanic (reference group)	1.00	1.00	1.00	1.00
Hispanic, any race	0.70 (0.61–0.81)	0.83 (0.75–0.92)	0.75 (0.65–0.86)	0.94 (0.85–1.04)
Nonwhite, non-Hispanic	0.95 (0.84–1.07)	0.96 (0.86–1.08)	1.05 (0.92–1.19)	1.07 (0.95–1.19)
Family composition^g
2 Parents in household (reference group)	1.00	1.00	1.00	1.00
1 Parent in household	1.19 (1.06–1.34)	1.01 (0.93–1.10)	1.20 (1.08–1.33)	1.00 (0.92–1.09)
At least 1 parent completed high school
Yes (reference group)	1.00	1.00	1.00	1.00
No	1.03 (0.91–1.17)	1.20 (1.09–1.31)	1.10 (0.98–1.25)	1.22 (1.10–1.35)
At least 1 parent employed
Not currently employed (reference group)	1.00	1.00	1.00	1.00
Employed/self-employed	1.00 (0.85–1.19)	1.10 (0.97–1.25)	1.01 (0.85–1.19)	1.10 (0.95–1.26)
Geographic residence
Northeast (reference group)	1.00	1.00	1.00	1.00
West	1.72 (1.40–2.12)	1.84 (1.56–2.18)	1.49 (1.20–1.85)	1.55 (1.29–1.87)
South	1.93 (1.62–2.29)	1.76 (1.50–2.06)	1.75 (1.47–2.08)	1.56 (1.31–1.86)
Midwest	1.81 (1.48–2.22)	1.68 (1.41–2.00)	1.73 (1.41–2.13)	1.51 (1.25–1.83)
Child health status
Excellent (reference group)	1.00	1.00	1.00	1.00
Not excellent	0.97 (0.89–1.06)	0.84 (0.78–0.90)	1.00 (0.92–1.10)	0.86 (0.79–0.93)

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The Article in Brief

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

Jennifer E. DeVoe , and colleagues

Background Research has shown that children with health insurance have better access to care than uninsured children; however, less is known about how parents' insurance coverage affects their children�s care. This study examined relationships between different family insurance patterns and children�s access to health care and preventive medical services.

What This Study Found When parents lack health insurance, their insured children are more likely to go without necessary medical and preventive services. Among 43,509 US children 2 to 17 years old, insured children with uninsured parents had higher odds of an insurance coverage gap, no usual source of care, unmet health care needs, and not receiving at least one preventive counseling service compared with insured children with insured parents.

Implications

Based on the study findings, if the current trend continues, the majority of US children will soon live in families with discordant and disrupted patterns of family health insurance.
The authors call for policy makers to look beyond child-only insurance models. They describe an urgent need to replace the current patchwork of public insurance and private insurance with a new comprehensive model that provides a basic level of stable coverage to all families and everyone in the family.