Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling

Abstract

Objectives Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. Methods We conducted secondary analyses of 2002-2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n=49,947). Results. Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12-1.31); regular exercise (aRR 1.06, 95% CI 1.01-1.12), use of car safety devices (aRR 1.10, 95% CI 1.03-1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05-1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04-1.20). Conclusions A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.

Receipt of Preventive Health Services in Young Adults

“…This is consistent with findings from studies in the pediatric and adult population, where the presence of usual source of care plays an important role in improving access to health education and counseling (10-13) (26). Usual source of care is a component of the medical home concept that is widely used to improve quality of care for transition-aged adolescents (27, 28).…”

Factors Influencing Family Physicians' Contribution to the Child Health Care Workforce

“…1 Children with a usual source of care have better health outcomes, including more preventive health counseling and fewer avoidable hospitalizations, than children who do not. [2][3][4] Furthermore, access to patient-centered, comprehensive primary care has been shown to improve delivery of preventive services and decrease unmet medical needs of children. 5,6 Pediatricians and family physicians make up the majority of the current physician workforce responsible for providing primary care for children.…”

Treatment Fidelity of Motivational Interviewing Delivered by a School Nurse to Increase Girls' Physical Activity

“…Encouraging findings have been reported from the use of motivational interviewing in office–based settings to prevent or treat an overweight or obesity problem among children and adolescents (Pollak et al, 2009; Schwartz et al, 2007). Unfortunately, many school-age children and adolescents do not have easy access to this type of health care setting (DeVoe, Tillotson, Wallace, Lesko, & Pandhi, 2011). …”