Health Insurance and Access to Primary Care for Children

Newacheck, Paul W.; Stoddard, Jeffrey J.; Hughes, Dana; Pearl, Michelle

doi:10.1056/nejm199802193380806

Cited by 364 publications

(210 citation statements)

References 16 publications

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“…Previous research has established that individuals without health insurance have poor access to medical care across a number of important indicators, including having a usual source of medical care, having at least one physician visit during a given year, and having confi dence that they can obtain care when needed (Haley and Zuckerman 2000;Hoffman et al 2001;Kasper, Giovannini, and Hoffman 2000;Nelson et al 1999;Newacheck et al 1998;Newacheck et al 1999;Shi 2000;Zuvekas and Weinick 1999). Individuals without health insurance are also more likely to forgo preventive and routine care for chronic conditions (Ayanian et al 2000).…”

Section: The Consequences Of Being Uninsuredmentioning

confidence: 99%

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

2010

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Millions of people in the United 2002a;Osteen et al. 1994;Roetzheim et al. 1999). Being uninsured also poses serious fi nancial threats to Americans, with millions carrying a large burden of debt from medical expenses ( Himmelstein et al. 2005). Although public programs-such as Medicaid and the State Children's Health Insurance Program (SCHIP)-provide health insurance to many who would otherwise not be able to afford coverage, millions are without health insurance.In this article, we argue that current research offers a limited description of health insurance coverage in the United States, especially with respect to racial disparities. More specifi cally, the literature to date does not give a sense of the duration of exposure to being uninsured over a typical lifetime, nor does it address the joint risk of being uninsured and being unhealthy. Yet, having an estimate of the duration of time that individuals typically live with these risks is essential in assessing the magnitude of the insurance-related challenges facing the United States. Moreover, having durational measures of the joint risk of being uninsured and in different health states is particularly important when examining disparities between whites and blacks because blacks are not only more likely to be uninsured but also more likely to experience adverse health events. In this study, we use a life table approach to examine racial differences in health insurance coverage in the United States by calculating health-and insurance-specifi c life expectancies for whites and blacks. These measures capture the duration of exposure to different insurance and health states during a typical lifetime. In the absence of individual data on lifetime insurance coverage, life table analysis is a valuable tool that enables us to simulate life course experiences with health insurance coverage and health. By creating measures with a focus on the lifetime exposure to the joint risks of being uninsured and less healthy, we hope not only to provide a better understanding of issues related to health insurance coverage in the United States but also to elucidate racial disparities in the current U.S. health care system. Specifi cally, we address three important questions. First, how does the proportion of time spent in different health and insurance states over the course of one year differ by age and race? Second, given current age-specifi c mortality, subjective health, and health insurance rates in the United States, how many years can individuals expect to live with different types of insurance coverage and in different health states over a typical lifetime? Third, how large are the differences between blacks and whites in the expected number of years lived in different health-specifi c insurance states? BACKGROUND

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Section: The Consequences Of Being Uninsuredmentioning

confidence: 99%

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

2010

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“…[7][8][9][10][15][16][17][18][19][20][21] Poverty and lack of health insurance contribute to racial and ethnic disparities in care. Low-income children are more likely to be uninsured, 22 and uninsured children are more likely than insured children to lack a usual source of health care, 11,[23][24][25][26] delay care, 23,26 use less care, [26][27][28][29][30] receive poorer quality care, 31 and have poorer health. 7,11,32,33 Because minority children are disproportionately likely to be both low income and uninsured, their problems are compounded.…”

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confidence: 99%

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Shone¹,

et al. 2005

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ABSTRACT. Background. Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll.Objectives. The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors.Methods. Pre/post-parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP.Results. Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured >12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/ most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period.Conclusions. Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care. R acial/ethnic disparities in health care delivery are associated with adverse hea...

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“…This is problematic because insurance discontinuities are associated with higher rates of unmet medical and prescription drug needs and a lack of recommended preventive health services similar to the uninsured [12][13][14]: all leading to poorer health [15]. In comparison, having continuous health insurance leads to better access to health care and improved health outcomes [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Children’s Health Insurance Coverage Discontinuity in 1998 Versus 2009: Parental Coverage Continuity Plays a Major Role

DeVoe

Tillotson

Angier

et al. 2014

Matern Child Health J

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To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children's Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child's coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14. 48-22.29 in 1998; RR 12.88, 95 % CI 10.41-15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99-40.53 in 1998; aRR 25.54, 95 % CI 19.41-33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06-8.06 in 1998; aRR 4.53, 95 % CI 3.40-6.04 in 2009). Parental coverage continuity has a major influence on children's coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, 'churning' on and off programs due to income fluctuations could result in coverage

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Health Insurance and Access to Primary Care for Children

Abstract: 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.

Cited by 364 publications

References 16 publications

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Predictors of Children’s Health Insurance Coverage Discontinuity in 1998 Versus 2009: Parental Coverage Continuity Plays a Major Role

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