Elsevier

Journal of Pediatric Health Care

Volume 26, Issue 5, September–October 2012, Pages e25-e35
Journal of Pediatric Health Care

Article
The Effects of Health Insurance and a Usual Source of Care on a Child’s Receipt of Health Care

An abstract with similar findings was presented at the North American Primary Care Research Group Annual Meeting in Seattle, Washington, November 2010.
https://doi.org/10.1016/j.pedhc.2011.01.003Get rights and content

Abstract

Introduction

Although recent health care reforms will expand insurance coverage for U.S. children, disparities regarding access to pediatric care persist, even among the insured. We investigated the separate and combined effects of having health insurance and a usual source of care (USC) on children’s receipt of health care services.

Methods

We conducted secondary analysis of the nationally representative 2002-2007 Medical Expenditure Panel Survey data from children (≤ 18 years of age) who had at least one health care visit and needed any additional care, tests, or treatment in the preceding year (n = 20,817).

Results

Approximately 88.1% of the study population had both a USC and insurance; 1.1% had neither one; 7.6% had a USC only, and 3.2% had insurance only. Children with both insurance and a USC had the fewest unmet needs. Among insured children, those with no USC had higher rates of unmet needs than did those with a USC.

Discussion

Expansions in health insurance are essential; however, it is also important for every child to have a USC. New models of practice could help to concurrently achieve these goals.

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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    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.

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