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Trends in Access to Health Care Services for US Children: 2000-2014
Kandyce Larson1, William L Cull1, Andrew D Racine2
1Division of Health Services Research and.
Insights
Child health insurance access improved significantly from 2000-2014, with notable gains for minority and low-income children in accessing healthcare services.
Area of Science:
- Pediatric Health Services Research
- Health Disparities
- Public Health Policy
Background:
- Substantial improvements in health insurance coverage for children have been observed.
- Few studies have comprehensively analyzed trends in diverse child health access indicators.
- Understanding these trends across different racial/ethnic and income groups is crucial.
Purpose of the Study:
- To examine trends in US children's access to health services from 2000 to 2014.
- To determine if these access trends differ by race/ethnicity and socioeconomic status.
- To assess changes in health insurance and key access indicators.
Main Methods:
- Analysis of 178,038 children (ages 0-17) from the National Health Interview Survey (2000-2014).
- Examined trends in health insurance and five access indicators: well-child visits, doctor visits, dental visits, usual source of care, and unmet health needs.
- Utilized logistic regression and statistical interaction models to control for sociodemographics, health status, and test for group differences.
Main Results:
- Uninsured rates for children declined from 12.1% to 5.3% between 2000 and 2014.
- Significant improvements were seen across all five access indicators for all children.
- Hispanic and Black children, as well as those in poor and near-poor families, demonstrated greater improvements in access compared to white children and those in higher income brackets.
Conclusions:
- Children's access to healthcare services has improved since 2000, with particularly significant gains among vulnerable populations.
- These findings underscore the positive impact of health insurance expansion on child health access.
- Continued support for health insurance programs for all children is recommended to sustain and further improve access.
Background And Objective:
Recent years have witnessed substantial gains in health insurance coverage for children, but few studies have examined trends across a diverse set of access indicators. We examine US children's access to health services and whether trends vary by race/ethnicity and income.
Methods:
Analysis of 178 038 children ages 0 to 17 from the 2000 to 2014 National Health Interview Survey. Trends are examined for health insurance and 5 access indicators: no well-child visit in the year, no doctor office visit, no dental visit, no usual source of care, and unmet health needs. Logistic regression models add controls for sociodemographics and child health status. Statistical interactions test whether trends vary by race/ethnicity and income.
Results:
Among all children, uninsured rates declined from 12.1% in 2000 to 5.3% in 2014, with improvement across all 5 access indicators. Along with steep declines in the uninsured rate, Hispanic children had sizeable improvement for no doctor office (19.8% to 11.9%), no dental visit (43.2% to 21.8%), and no usual source of care (13.9% to 6.3%). Black children and those in poor and near-poor families also had large gains. Results from adjusted statistical interaction models showed more improvement for black and Hispanic children versus whites for 3 of 5 access indicators and for children in poor and near-poor families for 4 of 5 access indicators.
Conclusions:
Children's access to health services has improved since 2000 with greater gains in vulnerable population groups. Findings support a need for continued support of health insurance for all children.
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