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Disparities in Health Insurance and Health care Access for Immigrant Children With Special Health care Needs
Katherine E Douglas1, Michael C Monuteaux1, Katherine R Peeler2
1Division of Emergency Medicine, Boston Children's Hospital (KE Douglas, MC Monuteaux, CG Coughlin, and LK Lee), Boston, Mass.
Insights
Immigrant children with special healthcare needs face significant disparities in health insurance and access to primary and sick care compared to their US-born peers. Addressing these inequities is crucial for improving health outcomes.
Area of Science:
- Pediatric Health Services Research
- Health Disparities Research
- Immigrant Health
Background:
- Children and Youth with Special Healthcare Needs (CYSHCN) often require consistent and coordinated medical care.
- Understanding healthcare access for diverse CYSHCN populations, including immigrant children, is vital for equitable health outcomes.
- Previous research indicates potential disparities in healthcare access for vulnerable pediatric populations.
Purpose of the Study:
- To compare healthcare access between immigrant and US-born CYSHCN.
- To identify specific areas of disparity in health insurance and care utilization for immigrant CYSHCN.
- To inform policy and practice aimed at reducing healthcare access gaps.
Main Methods:
- Cross-sectional, retrospective analysis of National Survey of Children's Health data (2016-2022).
- Inclusion of CYSHCN, comparing immigrant and US-born children based on nativity.
- Assessment of outcomes including health insurance, usual source of care, foregone care, and referral difficulties using multivariable logistic regression.
Main Results:
- Immigrant CYSHCN exhibited higher rates of inadequate insurance and lack of a usual source for primary and sick care compared to US-born CYSHCN.
- Multivariable analysis confirmed immigrant CYSHCN had lower odds of uninterrupted health insurance, usual primary care, and usual sick care.
- No significant differences were found in foregone medical care or difficulty with referrals between the two groups.
Conclusions:
- Immigrant CYSHCN experience significant disadvantages in accessing essential healthcare services, including insurance and regular care.
- These identified health disparities among immigrant CYSHCN necessitate targeted interventions to ensure equitable health outcomes.
- Addressing these access barriers is critical for the well-being of all CYSHCN, regardless of birthplace.
Objective:
Our objective was to examine health care access disparities for children and youth with special health care needs (CYSHCN), comparing immigrant and US-born CYSHCN.
Methods:
This was a cross-sectional, retrospective study of 2016 to 2022 National Survey of Children's Health data including CYSHCN. The primary exposure was child nativity. Primary outcomes were adequate health insurance, usual place for primary care, usual place for sick care, foregone medical care, and difficulty with referrals. We calculated descriptive frequencies and performed univariate analyses with the chi-square statistic. We then estimated multivariable logistic regression models evaluating each of the 5 outcomes, adjusting for individual and state-level characteristics.
Results:
From 2016 to 2022, 62,391 US-born children and 1733 immigrant children were identified as CYSHCN [population estimates: US-born 13,518,819 (19.5%), immigrant 462,757 (14.9%)]. Immigrant compared to US-born CYSHCN had higher rates of inadequate insurance, not having a usual place of primary care, and not having a usual place for sick care (P<.001). In multivariable models, immigrant CYSHCN had lower odds of uninterrupted health insurance (aOR 0.57, 95%CI 0.37, 0.87), usual place for primary care (aOR 0.59, 95%CI 0.37, 0.92), and usual place for sick care (aOR 0.67, 95%CI 0.50, 0.89) compared to US-born CYSHCN. There were no statistically significant differences for foregone medical care or difficulty with referrals.
Conclusions:
Immigrant compared to US-born CYSHCN in our study had worse access to health insurance, primary care, and sick care. Given the significant health care needs of CYSHCN, these health disparities must be addressed to improve their health outcomes.
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