Objectives. We examined the relation between parents’ level of English proficiency and their children’s access to health care. Methods. Using the 2001 California Health Interview Survey, we conducted bivariate and multivariate analyses of several measures of children’s access to health care (current health insurance status, usual source of care, emergency room visits, delayed or forgone care, traveling to another country for health care, and perceived discrimination in health care) and their association with parents’ English proficiency. Results. Compared with English-speaking households, children in non–English-speaking households were more likely to lack health insurance, to not have doctor contact, and to go to other countries for health care and were less likely to use emergency rooms. Their parents were less likely to report their children’s experiencing delayed or forgone care or discrimination in health care. Conclusion. English proficiency is a strong predictor of access to health insurance for children, and children in non–English-speaking families are especially likely to rely on other countries for their health care. English proficiency may mitigate the effects of race/ethnicity commonly observed in health care access and utilization studies.
ABSTRACT.Objective. This study examines patterns of specialist use among children and adolescents by presence of a chronic condition or disability, insurance, and sociodemographic characteristics.Design. Cross-sectional analysis of national survey data, describing rates of specialist use, with logistic regressions to examine associations with having a chronic condition or disability, insurance status, and sociodemographic variables.Setting. The 1999 National Health Interview Survey, a nationally representative household survey.Participants. Children and adolescents 2 to 17 years old.Outcome. Parental/respondent reports of specialist visits based on reports of the child having seen or talked to a medical doctor who specializes in a particular medical disease or problem about the child's health during the last 12 months.Results. Thirteen percent of US children were reported as seeing a specialist in the past year. Specialistvisit rates were twice as high for children with a chronic condition or disability (26% vs 10.2%). The specialist utilization rates for children without insurance were much lower than those for insured children, but among the children who have coverage (private, Medicaid, or other), specialist-utilization rates were similar (no statistically significant difference).Results of multivariate analyses predicting the use of specialists confirm the above-mentioned findings. Additionally, they show that use of specialist care was lower among children in the middle age group, minorities, children in families between 100% and 200% of the federal poverty level, and lower parental educational levels. We found no difference in specialist-visit rates between rural-and urban-dwelling children, by family status, or by gender. Differences in specialist use by gatekeeping status are found only among subgroups.Conclusions. The results showed that, overall, 13% of children used a specialist in a year. Among the insured, a slightly greater percentage of children used such care (15%). These numbers were slightly lower than the 18% to 28% of pediatric patients referred per year in 5 US health plans, although the sources of data and definitions of specialist use differ. Our results showed that 26% of children with a chronic condition or disability who were insured by Medicaid use a specialist. Although the data are not directly comparable, this is within the range of previous findings showing annual rates by condition of use between 24% and 59%. These findings are consistent also with greater use of many different types of health care by children with special health care needs.Medicaid-utilization rates presented here were similar also to the rates found among privately insured children and children with "other" insurance. In our earlier work examining use of specialists by children insured by Medicaid, we speculated that Medicaid-insured children might face particular difficulty with access (eg, due to transportation or language barriers). The findings presented here suggest that children insured by Medicaid had no ...
Objective. To examine whether known Medicaid enrollees misreport their health insurance coverage in surveys and the extent to which misreports of lack of coverage bias estimates of uninsurance. Data Source. Primary survey data from the Medicaid Undercount Experiment. Study Design. Analyze new data from surveys of Medicaid enrollees in California, Florida, and Pennsylvania and summarize existing research examining bias in coverage estimates due to misreports among Medicaid enrollees. Data Collection Method. Subjects were randomly drawn from Medicaid administrative records and were surveyed by telephone. Principal Findings and Conclusions. Cumulative evidence shows that a small percentage of Medicaid enrollees mistakenly report being uninsured, resulting in modest upward bias in estimates of uninsurance. A somewhat larger percentage of enrollees report having some other type of coverage than no coverage, biasing Medicaid enrollment estimates downward but not biasing estimates of uninsurance significantly upward. Implications for policy makers' confidence in survey estimates of coverage are discussed.Key Words. Validation study, health insurance coverage, survey and administrative data, Medicaid undercount There is consensus among researchers that population surveys of health insurance coverage undercount the number of individuals enrolled in Medicaid
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