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Health care access after injury by insurance type in a pediatric population
Sarah Grim Hostetler1, Huiyun Xiang, Kelly Kelleher
1Center for Injury Research and Policy, Columbus Children's Hospital and Children's Research Institute, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43205, USA.
Insights
Uninsured children are more likely to be hospitalized after an injury than insured children, a finding that differs from routine care access patterns. This study examined urgent medical care utilization following injuries in children based on insurance status.
Area of Science:
- Pediatric Health
- Health Services Research
- Injury Epidemiology
Background:
- Disparities in healthcare access by insurance status are documented for routine care.
- Limited data exists on whether these disparities extend to urgent/emergent medical situations.
Purpose of the Study:
- To investigate the relationship between insurance type and healthcare utilization following injuries in children.
- To determine if insurance status influences seeking medical care after an injury.
Main Methods:
- Analysis of 1847 injuries in children under 18 using the 2000-2002 National Health Interview Survey.
- Multivariate logistic regression controlled for confounding variables to assess insurance type's association with seeking care (telephone call vs. hospitalization).
Main Results:
- No significant difference in seeking only telephone care post-injury across insurance types.
- Uninsured children demonstrated a significantly higher likelihood of hospitalization after an injury compared to privately insured or other insured groups.
Conclusions:
- Insurance type was not associated with making only a telephone call after an injury.
- Uninsured children face a greater likelihood of hospitalization post-injury, diverging from typical healthcare utilization patterns.
- Findings highlight potential access barriers for urgent pediatric care among uninsured children.
Objectives:
Previous studies demonstrate discrepancies in health care access by insurance status for routine, discretionary care. It is unknown whether these discrepancies in health care utilization by insurance status persist in urgent/emergent circumstances. We used injury as a sentinel event to represent urgent/emergent medical conditions to examine the relationship with insurance type.
Methods:
Using the 2000, 2001, and 2002 National Health Interview Survey, we examined medical care sought after 1847 injuries among children younger than 18 years. We performed univariate analyses to explore the relationship of insurance type and demographic variables with medical care sought. We then conducted multivariate logistical regression analysis to assess the association of insurance type with only making a telephone call and with being hospitalized while controlling for confounding variables. There was no direct measure in injury severity in these data.
Results:
Although uninsured children had the lowest percentage of head injuries, there was no significant difference in body part injured by insurance type. While controlling for potentially confounding variables, there were no significant differences for making only a telephone call after an injury by insurance type [OR (95% CI): 1.29 (0.45-3.72) for private insurance; 1.13 (0.28-4.62) for other insurance types; 0.69 (0.08-6.33) for uninsured; Medicaid as the reference]. However, uninsured children had a significantly increased likelihood of being hospitalized after an injury [OR (95% CI): 4.07 (1.13-14.66) compared with 2.21 (0.73-6.63) for privately insured; 1.61 (0.47-5.55) for other insurance types; Medicaid as the reference].
Conclusions:
While controlling for potentially confounding variables, there was no relationship between type of insurance and only making a telephone call after an injury. However, uninsured children were significantly more likely to be hospitalized after an injury than insured children. This latter relationship differs from overall patterns of health care utilization by insurance type.
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