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Ontario Child Health Study: patterns of ambulatory medical care utilization and their correlates
C A Woodward1, M H Boyle, D R Offord
1Department of Psychiatry, McMaster University, Hamilton, Ontario, Canada.
Insights
Parent-perceived physical health status is the main driver of pediatric ambulatory medical care use. Frequent users, defined as three or more services in six months, consumed most care, indicating health status impacts healthcare access.
Area of Science:
- Pediatric Health Services Research
- Epidemiology
- Health Economics
Background:
- Universal, first-dollar health insurance aims to reduce financial barriers to healthcare access.
- Understanding patterns of ambulatory medical care utilization is crucial for resource allocation and public health planning.
Purpose of the Study:
- To examine the frequency and correlates of ambulatory medical care use among Ontario children (4-16 years) under a universal insurance plan.
- To identify key determinants of both the use/nonuse and the frequency of ambulatory medical care visits.
Main Methods:
- Analysis of data from a large-scale epidemiologic survey of children.
- Description of utilization patterns across different ambulatory care settings (doctor's offices, emergency rooms, hospital outpatient departments).
- Application of regression analyses to predict ambulatory medical care use and visit frequency.
Main Results:
- A small proportion of children (frequent users) accounted for a significant majority (nearly two-thirds) of all ambulatory care services.
- Parent-perceived child's physical health status was the primary determinant of both ambulatory medical care use and frequency.
- Younger age, urban residence, number of chronic conditions, and higher maternal education were associated with increased use.
Conclusions:
- Child's health status is the most significant factor influencing ambulatory medical care utilization, even with universal insurance.
- Mental health issues and parental mental health history were associated with high users.
- Family size and socioeconomic status were not significant predictors, suggesting insurance effectively reduced these barriers.
Abstract:
Data from a large epidemiologic survey of Ontario children 4 to 16 years of age are presented concerning the frequency and correlates the use of ambulatory medical care services during a 6-month period in which a universal, first-dollar health insurance plan was used. Patterns of use of ambulatory medical care are described for three settings: doctor's offices, emergency rooms, and hospital outpatient departments. A group of children who are frequent users of ambulatory medical care (defined as using three or more services in 6 months) consumed nearly two thirds of all services. Two regression equations are presented--one predicting use/nonuse of ambulatory medical care and the other predicting the total number of visits for medical care. Although only a small proportion of the variance in use/nonuse and amount of use was explained, the major determinant of both ambulatory medical care use and frequency of use was the child's physical health status as perceived by the parent. Younger child, urban area of residence, the number of chronic medical problems of the child, and higher level of maternal education also contributed to the explanation of use v nonuse. Among ambulatory medical care users, high users were more likely to be described as having mental health problems and have parents who had been treated for "nerves." Family size and socioeconomic variables were not important factors in use, suggesting that universal health insurance reduces some barriers to ambulatory medical care for children.