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Access to care for poor children. Separate and unequal?
R F St Peter1, P W Newacheck, N Halfon
1Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco 94143-0903.
Insights
Medicaid improves access to routine care for poor children, but they are less likely to receive care in physicians' offices and have less continuity of care compared to other children.
Area of Science:
- Health Services Research
- Pediatric Health
- Public Health Policy
Background:
- Access to preventive care is crucial for child development and long-term health outcomes.
- Medicaid is a vital public health insurance program for low-income families in the United States.
- Understanding care utilization patterns among Medicaid-enrolled children is essential for policy evaluation.
Purpose of the Study:
- To examine the impact of Medicaid coverage on preventive care use, care location, and continuity for impoverished children.
- To compare care access and continuity for children with and without Medicaid coverage.
Main Methods:
- Analysis of a nationally representative sample of 17,710 US children from the 1988 National Health Interview Survey on Child Health.
- Assessment of usual source of care, timeliness of visits, usual care location, and continuity of care.
- Stratified cluster sampling of US households ensured a representative participant pool.
Main Results:
- Poor children with Medicaid demonstrated higher rates of having a usual source of routine care (91% vs. 78%) and timely routine visits (84% vs. 69%) compared to uninsured poor children.
- However, Medicaid-enrolled children were less likely to receive routine care in physicians' offices (56% vs. 82%) and more prone to continuity gaps between routine and sick care (18% vs. 6%).
- Children receiving care at community clinics were more likely to have disparate locations for routine and sick care and to utilize emergency departments for sick care.
Conclusions:
- Medicaid enhances access to routine preventive care for low-income children.
- Despite improved access, Medicaid does not guarantee equivalent care locations or continuity compared to children above the poverty line.
- Ongoing policy adjustments may mitigate some disparities, but persistent inequities in care delivery are anticipated.
Objective:
To determine how coverage by Medicaid affects the use of preventive care, as well as the location and continuity of care for poor children.
Design:
Analysis of the 1988 National Health Interview Survey on Child Health.
Setting:
Nationally representative sample of the US noninstitutionalized, civilian population.
Participants:
A total of 17,710 children under 18 years of age selected in a stratified cluster sampling of US households.
Intervention:
None.
Main Outcome Measures:
The percentage of children with a usual source of routine care; the timeliness of visits for routine care; the usual source where routine care is received; and the continuity between sources of care.
Results:
Poor children with Medicaid coverage were more likely than those without Medicaid to have a usual source of routine care (91% vs 78%, P less than .001) and to receive routine care within an appropriate time interval (84% vs 69%, P less than .001). However, poor children with Medicaid were less likely than children living above the poverty line to receive routine care in physicians' offices (56% vs 82%, P less than .001) and more likely to lack continuity between usual sources of routine and sick care (18% vs 6%, P less than .001). Children receiving routine care at community clinics compared with children receiving care at physicians' offices were more likely to receive sick care at a different location than where they receive routine care (40% vs 4%, P less than .001) and also more likely to identify an emergency department as their usual source of sick care (9% vs 2%, P less than .001).
Conclusions:
While Medicaid does improve access to care for poor children, it does not ensure them access to the same locations and continuity of care as that available to other children. Recent changes in the Medicaid program may address some of these inequities, but others are likely to remain.
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