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Usual source of care and unmet need among vulnerable children: 1998-2006
Leesha K Hoilette1, Sarah J Clark, Achamyeleh Gebremariam
1University of Michigan, 300 N Ingalls, Room 6C15, Ann Arbor, MI 48109-5456, USA. leeshah@med.umich.edu
Insights
Growing numbers of uninsured children lack a usual source of care, increasing unmet medical needs. Access to healthcare requires both insurance coverage and consistent care sources for children.
Area of Science:
- Pediatric Health Services Research
- Health Insurance Access
- Healthcare Disparities
Background:
- Publicly funded insurance programs like Medicaid and the State Children's Health Insurance Program (SCHIP) aim to improve children's access to healthcare.
- Despite insurance expansion, disparities in healthcare access and unmet medical needs persist among vulnerable child populations.
Purpose of the Study:
- To determine the proportion of publicly insured and uninsured children without a usual source of care between 1998 and 2006.
- To characterize unmet medical needs in relation to insurance status and usual source of care for these children.
Main Methods:
- Secondary data analysis of the National Health Interview Survey (1998-2006).
- Identification and stratification of children (0-17 years) lacking a usual source of care.
- Comparison of odds of unmet medical need based on insurance and usual care source.
Main Results:
- Significant increases in Medicaid and SCHIP enrollment were observed.
- The proportion of uninsured children remained stable, but those reporting no usual source of care increased.
- Uninsured children and those without a usual source of care faced the highest odds of unmet medical need.
Conclusions:
- Initiatives during SCHIP and the President's Health Center Initiative saw rising numbers of uninsured children without a usual source of care.
- Unmet medical needs were most prevalent among uninsured children and those lacking a usual source of care.
- Effective access-to-care strategies must integrate expanded insurance coverage with improved access to consistent sources of care.
Objective:
The purpose of this work was to identify the proportions of publicly (Medicaid and State Child Health Insurance Program) insured and uninsured children who did not identify a usual source of care from 1998 to 2006, spanning the State Children's Health Insurance Program (1997 to present) and the President's Health Center Initiative (2002 to present), and to characterize unmet medical need as it relates to insurance and a usual source of care for publicly insured and uninsured children.
Methods:
We conducted a secondary data analysis of multiple years of the National Health Interview Survey. We identified the proportion of publicly insured and uninsured children aged 0 to 17 years who did not identify a usual source of care and stratified according to the site of care. We described the odds of reporting an unmet medical need according to insurance status and usual source of care, compared with privately insured children with a usual source of care. Sample weights were used to derive national estimates.
Results:
From 1998 through 2006, there were significant increases in the proportions of children enrolled in Medicaid (16.7%-24.5%) and the State Child Health Insurance Program (2.0%-5.3%). The proportion of uninsured children has remained stable from 2002 to 2006 at approximately 10%. However, the proportion of uninsured reporting no usual source of care increased from 17.8% to 23.3%. Hispanic children had significant increases in the proportions of the uninsured and reporting no usual source of care by 2006. Hispanics constituted the largest proportion in both groups. Uninsured children and children without a usual source of care reported the highest odds of unmet need. Among the insured, publicly insured children had twice the odds of reporting an unmet need compared with privately insured children.
Conclusions:
During the State Child Health Insurance Program and the President's Health Center Initiative, growing proportions of uninsured children reported no usual source of care. Unmet medical need was the highest for the uninsured and those without a usual source of care. These findings suggest that initiatives designed to improve access to care must combine broadened insurance coverage with enhanced access to usual sources of care.
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