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Health insurance and access to primary care for children
P W Newacheck1, J J Stoddard, D C Hughes
1Institute for Health Policy Studies, Department of Pediatrics, University of California, San Francisco 94109, USA.
Insights
Health insurance significantly impacts children's primary care access. Uninsured children face greater barriers to consistent medical attention and have lower physician contact rates, highlighting insurance's crucial role.
Area of Science:
- Pediatric Health Services Research
- Health Insurance Policy
- Access to Care Studies
Background:
- Insurance status is known to affect ambulatory care for children.
- Limited research has explored insurance as a key factor in children's primary care access.
Purpose of the Study:
- To investigate the influence of health insurance on children's access to primary health care.
- To quantify disparities in primary care access based on insurance status.
Main Methods:
- Analysis of a large national dataset (49,367 children) from the 1993-1994 National Health Interview Survey.
- Inclusion of survey data on insurance coverage and primary care access indicators.
- Statistical control for potential confounding factors using regression analyses.
Main Results:
- 13% of U.S. children lacked health insurance during 1993-1994.
- Uninsured children were significantly less likely to have a usual source of care (75.9% vs. 96.2%).
- Compared to insured peers, uninsured children experienced more barriers, including lack of a regular physician, after-hours care access issues, and unmet medical needs.
Conclusions:
- Health insurance is a critical determinant of primary care access for children.
- The Children's Health Insurance Program (CHIP) has the potential to significantly improve children's access to and utilization of primary care services.
Background:
Numerous studies have demonstrated that insurance status influences the amount of ambulatory care received by children, but few have assessed the role of insurance as a determinant of children's access to primary care. We studied the effect of health insurance on children's access to primary care.
Methods:
We analyzed a sample of 49,367 children under 18 years of age from the 1993-1994 National Health Interview Survey, a nationwide household survey. The overall rate of response was 86.5 percent. The survey included questions on insurance coverage and access to primary care.
Results:
An estimated 13 percent of U.S. children did not have health insurance in 1993-1994. Uninsured children were less likely than insured children to have a usual source of care (75.9 percent vs. 96.2 percent, P<0.001). Among those with a usual source of care, uninsured children were more likely than insured children to have no regular physician (24.3 percent vs. 13.8 percent, P<0.001), to be without access to medical care after normal business hours (11.8 percent vs. 7.1 percent, P<0.001), and to have families that were dissatisfied with at least one aspect of their care (19.6 percent vs. 14.0 percent, P=0.01). Uninsured children were more likely than insured children to have gone without needed medical, dental, or other health care (22.2 percent vs. 6.1 percent, P<0.001). Uninsured children were also less likely than insured children to have had contact with a physician during the previous year (67.4 percent vs. 83.8 percent, P<0.001). All differences remained significant after we controlled for potential confounders using linear and logistic regression.
Conclusions:
Among children, having health insurance is strongly associated with access to primary care. The new children's health insurance program enacted as part of the Balanced Budget Act of 1997 may substantially improve access to and use of primary care by children.