ArticleThe Effects of Health Insurance and a Usual Source of Care on a Child’s Receipt of Health Care
Section snippets
Data
We analyzed data from the Medical Expenditure Panel Survey–Household Component (MEPS-HC) (Agency for Healthcare Research and Quality [AHRQ], 2004). MEPS-HC is a large-scale survey conducted across the United States that collects specific health care service data on Americans from a sample of selected families. It includes items such as demographics, health conditions, services used, frequently of use, access to care, and health insurance coverage (AHRQ, 2009). The MEPS-HC utilizes a stratified
Results
Among children with at least one visit and a need for further health care services, 95.8% had a USC and 91.3% had health insurance. An estimated 88.1% had both a USC and insurance (Yes INS/Yes INS), while 1.1% had neither one (No INS/No USC) (Table 1). A higher percentage of children in this study population had health insurance and/or a USC compared with the entire U.S. population.
In two-tailed χ2 analyses, all of the demographic characteristics varied among the four insurance and/or USC
Discussion
This study addresses the separate and combined effects of insurance and a USC on children’s receipt of health care services and unmet needs. Not surprisingly, uninsured children without a USC were at highest risk for not receiving services. In comparing the two groups with either insurance or a USC, children with only health insurance (and no USC) encountered similar barriers to those with only a USC (and no health insurance). Children with only health insurance or only a USC fared better than
Conclusions
Incremental steps to expand children’s health insurance programs without efforts to bolster the availability of care and the coordination of care will lead to continued problems with children's inability to access necessary health care services. This study demonstrates that both expansion of health insurance and a USC for every child are important to receipt of high-quality pediatric health care services. It is also crucial that we simultaneously strengthen and coordinate financial and
Jennifer E. DeVoe, Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, OR.
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2019, Nursing OutlookCitation Excerpt :Thus, expanding public insurance access for adults and children improves pediatric health care access and health outcomes (Feinberg, Swartz, Zaslavsky, Gardner, & Walker, 2002; Flores et al., 2017; Sommers, Blendon, Orav, & Epstein, 2016; Sommers, Gunja, Finegold, & Musco, 2015; Vistnes, Lipton, & Miller, 2016). Affordable access to comprehensive health care insurance has also been repeatedly shown to predict receipt of high-quality pediatric health care (DeVoe, Ray, Krois, & Carlson, 2010; DeVoe et al., 2009; Devoe et al., 2012) and improvement in child health outcomes (Abdullah et al., 2010; Flores et al., 2016, 2017; Fry-Johnson et al., 2005). Universal, affordable access to health care, regardless of employment status or ability to pay insurers, would ensure that all children and their families can obtain critical preventive care for promoting health, regardless of income (Gorin, 1997; Lewis, 2004; Montagu & Goodman, 2016; Morgan, Ensor, & Waters, 2016; Potera, 2017; Rahman et al., 2017; Rashford, 2007).
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Jennifer E. DeVoe, Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, OR.
Carrie J. Tillotson, Research Analyst, Oregon Health & Science University, Portland, OR.
Lorraine S. Wallace, Associate Professor, University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, TN.
Sarah E. Lesko, Director, Center for Researching Health Outcomes, Mercer Island, WA.
Heather Angier, Research Associate, Department of Family Medicine, Oregon Health & Science University, Portland, OR.
This project was directly supported by grants 1 K08 HS16181 and 1 R01 HS018569 from the Agency for Healthcare Research and Quality (AHRQ) and the Oregon Health & Science University Department of Medicine. Indirect support was received from the Oregon Clinical and Translational Research Institute, grant No. UL1 RR024140 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. These funding agencies had no involvement in the design and conduct of the study; analysis and interpretation of the data; and preparation, review, or approval of the manuscript. AHRQ collects and manages the Medical Expenditure Panel Survey.
Conflicts of interest: None to report.