The Effects of Health Insurance and a Usual Source of Care on a Child’s Receipt of Health Care

DeVoe, Jennifer E.; Tillotson, Carrie J.; Wallace, Lorraine S.; Lesko, Sarah; Angier, Heather

doi:10.1016/j.pedhc.2011.01.003

Cited by 20 publications

(15 citation statements)

References 27 publications

(34 reference statements)

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“…SES indicators) for this analysis were maternal educational attainment, annual household income, and insurance type. For this study, education was considered a stable measure of SES (17), income was indicative of current access to resources (5, 18), and insurance status was a marker of access to healthcare services (6). We derived a composite socioeconomic index (SES index)(15, 19–21) for each participant by summing the ordinal rank scores as follows: Maternal educational level was categorized into low (less than high school graduate, score=1), medium (high school graduate, score=2), and high (some college or higher, score=3).…”

Section: Methodsmentioning

confidence: 99%

“…This discrepancy in asthma outcomes is multifactorial and greatly influenced by social adversities, such as poverty, that disproportionately affect African American populations (3). Socioeconomic status (SES) is often measured by educational level, annual household income, and insurance status (4–6). Individuals with low educational attainment are at high risk for poor health literacy (7), and low parental literacy is associated with moderate and severe persistent asthma as well as higher rescue medication use in children (8).…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic status and asthma control in African American youth in SAGE II

Thakur¹,

Martin²,

Castellanos³

et al. 2014

Journal of Asthma

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Objective African Americans are disproportionately burdened by asthma. We assessed the individual and joint contribution of socioeconomic status (SES) on asthma morbidity among African American youth. Methods We examined 686 African Americans (8–21 years) with asthma. To account for the joint effects of SES, a composite index was derived from maternal educational attainment, household income, and insurance status. Ordinal logistic regression was used to estimate the individual and joint effect of SES on asthma control. Models were adjusted for age, sex, controller medication use, in utero smoke exposure, family history of asthma, family history of rhinitis, breastfeeding, daycare attendance, and mold exposure. Results Participants were classified as Poorly Controlled Asthma (40.8%), Partially Controlled Asthma (29.7%), or Controlled Asthma (30.2%). Of the individual SES indicators, low income was the strongest predictor of poor asthma control. Children with low income had worse asthma control than those with higher income (OR 1.39; 95%CI 0.92–2.12). The SES index ranged from 4–9. SES was associated with 17% increased odds of poor asthma control with each decrease in the index (95%CI 1.05–1.32). The SES index was associated with asthma-related symptoms, nocturnal awakenings, limited activity, and missed school days. Conclusions The negative effects of SES were observed along the entire socioeconomic gradient, and the adverse asthma outcomes observed in African American youth were not limited to the very poor. We also found that the SES index may be a more consistent and useful predictor of poor asthma outcomes than each indicator alone.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Socioeconomic status and asthma control in African American youth in SAGE II

Thakur¹,

Martin²,

Castellanos³

et al. 2014

Journal of Asthma

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“…[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. While pediatricians account for a large proportion of physician visits by children, family physicians are named as the usual source of care for one-third of the child population and provide 16% to 21% of physician visits by children.…”

Section: Introductionmentioning

confidence: 99%

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

Makaroff¹,

Xierali

Petterson³

et al. 2014

The Annals of Family Medicine

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PURPOSE We wanted to explore demographic and geographic factors associated with family physicians' provision of care to children. METHODSWe analyzed the proportion of family physicians providing care to children using survey data collected by the American Board of Family Medicine from 2006 to 2009. Using a cross-sectional study design and logistic regression analysis, we examined the association of various physician demographic and geographic factors and providing care of children. RESULTSYounger age, female sex, and rural location are positive predictors of family physicians providing care to children: odds ratio (OR) = 0.97 (95% CI, 0.97-0.98), 1.19 (1.12-1.25), and 1.50 (1.39-1.62), respectively. Family physicians practicing in a partnership are more likely to provide care to children than those in group practice: OR = 1.53 (95% CI, 1.40-1.68). Family physicians practicing in areas with higher density of children are more likely to provide care to children: OR = 1.04 (95% CI, 1.03-1.05), while those in high-poverty areas are less likely 0.10 (95% CI, 0.10-0.10). Family physicians located in areas with no pediatricians are more likely to provide care to children than those in areas with higher pediatrician density: OR = 1.80 (95% CI, 1.59-2.01).CONCLUSIONS Various demographic and geographic factors influence the likelihood of family physicians providing care to children, findings that have important implications to policy efforts aimed at ensuring access to care for children.

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“…39 We have also shown that adults and children are both more likely to have unmet health care needs when they lack a USC, even if they have health insurance. 40,41 In this study, we report on the importance of a USC for both parent and child, even while controlling for parental and child health insurance. …”

mentioning

confidence: 98%

Parent and Child Usual Source of Care and Children's Receipt of Health Care Services

DeVoe¹,

Tillotson²,

Wallace³

et al. 2011

The Annals of Family Medicine

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PURPOSEIn the United States, children who have a usual source of care (USC) have better access to health care than those who do not, but little is known about how parental USC affects children's access. We examined the association between child and parent USC patterns and children's access to health care services. METHODSWe undertook a secondary analysis of nationally representative, crosssectional data from children participating in the 2002. We assessed 10 outcome measures: insurance coverage gaps, no doctor visits in the past year, less than yearly dental visits, unmet medical and prescription needs, delayed care, problems getting care, and unmet preventive counseling needs regarding healthy eating, regular exercise, car safety devices, and bicycle helmets.RESULTS Among children, 78.6% had a USC and at least 1 parent with a USC, whereas 12.4% had a USC but no parent USC. Children with a USC but no parent USC had a higher likelihood of several unmet needs, including an insurance coverage gap (adjusted risk ratio [aRR] 1.33; 95% confi dence interval [CI], 1.21-1.47), an unmet medical or prescription need (aRR 1.70; 95% CI 1.09-2.65), and no yearly dental visits (aRR 1.12; 95% CI 1.06-1.18), compared with children with a USC whose parent(s) had a USC.CONCLUSIONS Among children with a USC, having no parent USC was associated with a higher likelihood of reporting unmet needs when compared with children whose parent(s) had a USC. Policy reforms should ensure access to a USC for all family members. Ann Fam Med 2011;9:504-513. doi:10.1370/afm.1300. INTRODUCTIONT he association between having a usual source of care (USC) and improved access to health care services is well established in both adult and child populations. [1][2][3][4][5][6][7][8][9][10] Children with a USC have more consistent access to health care services, 2,9,11-15 which likely contributes to better overall health outcomes. 16,17 According to recent estimates, however, approximately 19% of adults and nearly 10% of children in the United States do not have a USC. Safety-net services are oversubscribed, and the availability of primary care is widely disparate, 18 leaving many families with few options for maintaining a relationship with a USC.Although previous research clearly supports the importance of the relationship between a child having a stable USC and that individual child's access to and utilization of recommended care, [1][2][3][4][5][6][7][8][9][10]19 little is known about whether a child's receipt of health care is associated with his or her parents' USC status. In fact, to our knowledge, no previous studies describe child-parent USC patterns or measure how parental USC status affects a child's access to health care services. Further, the effect a child's USC status has on access to health care has been documented without accounting for parental USC status.It is known that children with health insurance have higher odds of [20][21][22][23] In addition, child health care service utilization patterns are highly associated with mate...

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The Effects of Health Insurance and a Usual Source of Care on a Child’s Receipt of Health Care

Cited by 20 publications

References 27 publications

Socioeconomic status and asthma control in African American youth in SAGE II

Socioeconomic status and asthma control in African American youth in SAGE II

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

Parent and Child Usual Source of Care and Children's Receipt of Health Care Services

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