Racial/Ethnic Differences in Health Insurance Adequacy and Consistency among Children: Evidence from the 2011/12 National Survey of Children's Health

Abstract

BackgroundSurveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children’s (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months).Design and methodsWe used data from the 2011/2012 National Survey of Children’s Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups.ResultsStratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage.ConclusionsThis study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations.Significance for public healthAs the number of minority US children increases, monitoring racial/ethnic differences in health insurance coverage becomes critical in creating insurance programs that can provide adequate and consistent coverage. Using a nationally representative sample, the findings of this study suggest that low income and poor maternal health can adversely affect insurance consistency and adequacy for both minority and white children. This indicates that research studies on inequalities of healthcare coverage should also focus on underserved white populations of children as their insurance coverage is affected by similar factors as those for minority children. Elimination of inequalities may require targeted interventions that include the well-being of the entire family, cross-cultural education of healthcare providers, policy changes to grant low-income children with appropriate and reliable health insurance, and an ongoing monitoring of disparities by health plans.

Effects of citizenship status, Latino ethnicity, and household language on health insurance coverage for U.S. adolescents, 2007‐2016

“…In several states currently, Medicaid and CHIP eligibility income thresholds are higher for children ages 0‐5 than for those between ages 6 and 18, meaning that school‐aged children and adolescents are less likely to qualify for public coverage. Generally speaking, adolescents tend to have higher uninsured rates and less adequate insurance than younger children, and there is evidence that uninsured rates continue to climb from early adolescence until the mid‐20s . Additionally, adolescents face new developmental shifts and health care needs which may impact their engagement with the health care system at different levels .…”

“…Evidence suggests that while the uninsured rate declined steadily across this time period, much of the narrowing occurred after the passage of the ACA. Pre‐ACA, the uninsured rate among Latino youth dropped significantly between 2002 and 2009, but disparities with non‐Latino white youth remained notable and insurance coverage was more unstable for Latino and black youth compared to white youth . Between 2011 and 2015, Latinos aged 0‐17 experienced the biggest outright reduction in the uninsured rate compared to black and white youth.…”

Epinephrine Autoinjector Prescription Filling after Pediatric Emergency Department Discharge

“…We found that while NH-white patients had a higher fill rate compared to NHblackpatients and having in-state public insurance was associated with a lower fill rate than having private insurance, there was likely a concordance between being NH-blackand having public in-state insurance.This is consistent with the knowledge that minority children are significantly more likely to have public insurance compared to white children. 15 Interestingly, patients with out-of-state Medicaid did not have the same risk of low fill rates as those patients with in-state Medicaid. This study was conducted in Washington, DC which is unique in that in-state Medicaid is restricted to District of Columbia residents and therefor encompasses an entirely urban population; whereas out-of-state Medicaid is likely to be held by patients living in the Maryland and Virginia suburbs.…”

Impact of medical home-consistent care and child condition on select health, community, and family level outcomes among children with special health care needs

“…This is important to note because we know that poverty rates are higher for black and Hispanic children compared to white children, 34% and 28%, respectively, compared to 11% (U.S. Department of Commerce, Census Bureau, American Community Survey, 2017, as cited in National Center for Education Statistics, 2019). Further, racial/ethnic disparities in insurance consistency also persist (Soylu, Elashkar, Aloudah, Ahmed, & Kitsantas, 2018).…”