Disparities in Pediatric Provider Availability by Insurance Type After the ACA in California
Jessie Kemmick Pintor1, Héctor E Alcalá2, Dylan H Roby3
1Department of Health Management and Policy (JK Pintor, CK Alberto, RM McKenna, and AN Ortega), Dornsife School of Public Health, Drexel University, Philadelphia, Penn.
Insights
Children with Medi-Cal or private insurance faced greater provider barriers than those with employer-sponsored plans. These insurance-based disparities highlight access challenges in California's healthcare market.
Area of Science:
- Health Services Research
- Health Policy
- Pediatric Health
Background:
- The Affordable Care Act (ACA) reshaped the health insurance market.
- Understanding insurance-based disparities in healthcare access is crucial for vulnerable populations.
Purpose of the Study:
- To investigate provider-related barriers to care experienced by children in California.
- To examine how these barriers differ based on insurance type post-ACA.
Main Methods:
- Analysis of 6514 children (0-11 years) from the 2014-2016 California Health Interview Survey.
- Examined parent-reported difficulties in finding providers, provider acceptance, and insurance acceptance.
- Used multivariable models to assess associations between insurance type (Medi-Cal, employer-sponsored, private) and reported barriers.
Main Results:
- Approximately 8% of parents reported at least one provider barrier.
- Children with Medi-Cal (Medicaid) or privately purchased coverage had double the odds of experiencing barriers compared to those with employer-sponsored insurance.
- Medi-Cal enrollees faced higher odds of difficulty finding providers and being accepted as new patients. Privately insured children had higher odds of facing insurance acceptance issues.
Conclusions:
- Significant insurance-based disparities in provider-related barriers exist for children in California.
- Findings underscore the need for policies to mitigate these access barriers and ensure equitable care.
- The study highlights ongoing challenges in provider networks and acceptance across different insurance plans.
Objective:
To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act.
Methods:
Our sample included 6514 children (ages 0 to 11 years) from the 2014-2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, or 4) any of the above. Multivariable models estimated the associations of insurance type-Medi-Cal (Medicaid), employer-sponsored insurance, or privately purchased coverage-and parent reports of these problems.
Results:
Approximately 8% of parents had encountered at least one of these problems. Compared with parents of children with employer-sponsored insurance, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of being told a provider would not accept their children's coverage or having trouble finding a general provider and 3times the odds of being told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over 3times the odds of being told a provider would not accept their children's coverage.
Conclusions:
Our study found significant disparities in provider-related barriers by insurance type among children in California.
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