When Insurance Status Is Not Static: Insurance Transitions of Low-Income Children and Implications for Health and Health Care

Aiken, Kimberly D.; Freed, Gary L.; Davis, Matthew M.

doi:10.1367/a03-103r.1

Cited by 39 publications

(25 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous research on health insurance coverage indicates that children who experience gaps are less likely to have regular contact with a health care provider. [22][23][24] Mayer et al 25 examined insurance coverage gaps and vaccination status of young children and found children who had experienced any gaps were less likely to be UTD. A study of NIS data by Smith et al 26 found that 19-to 24-month-old children who had lapses in insurance coverage were significantly less likely to be UTD compared with children who had no breaks.…”

Section: Discussionmentioning

confidence: 99%

The Association of Health Insurance and Continuous Primary Care in the Medical Home on Vaccination Coverage for 19- to 35-Month-Old Children

2007

View full text Add to dashboard Cite

OBJECTIVE. Our goal was to examine the association of continuous care in the medical home and health insurance on up-to-date vaccination coverage by using data from the National Survey of Children's Health and the National Immunization Survey. METHODS. Interviews were conducted with 5400 parents of 19- to 35-month-old children to collect data on demographics and medically-verified vaccinations. Health insurance coverage was categorized as always, intermittently, or uninsured for the previous 12 months. Insurance types were private, public, or uninsured. Having a personal doctor or nurse and receiving preventive health care in either the past 12 or 24 months constituted continuous primary care in the medical home. Children were up-to-date if they received all vaccinations by 19 to 35 months of age (≥4 doses of diphtheria and tetanus toxoids and pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of any measles-containing vaccine, ≥3 doses of Haemophilus influenzae type b vaccine, and ≥3 doses of hepatitis B vaccine). RESULTS. Bivariate analyses revealed children who were always insured had significantly higher vaccination coverage (83%) than those with lapses or uninsured during the past 12 months (75% and 71%, respectively). Those with continuous primary care in the medical home had significantly higher coverage than those who did not (83% vs 75%, respectively). In multivariate analysis, the same pattern of association was observed for insurance status and medical home, but the only statistically significant association was for children of never-married mothers who had significantly lower coverage (74%) compared with children of married mothers (84%). CONCLUSIONS. Among children with the same insurance status and continuity of care in the medical home, children of single mothers were less likely to be up-to-date than children of married mothers. Interventions assisting single mothers to obtain preventive care for their children should be a priority.

show abstract

Section: Discussionmentioning

confidence: 99%

The Association of Health Insurance and Continuous Primary Care in the Medical Home on Vaccination Coverage for 19- to 35-Month-Old Children

2007

View full text Add to dashboard Cite

show abstract

“…Four risk factors with supporting evidence were not available in the database: low parent educational attainment, 12,19,23 single-parent household, 12,19,24,25 adolescent exposure to intimate partner violence, 27 and discontinuous insurance coverage. [29][30][31] Risk factors involving parents were based on biologic parents, regardless of whether they lived in the child's household. All 11 risk factors studied (Table 1) were analyzed as binary variables.…”

Section: Identification Of Social Complexity Risk Factorsmentioning

confidence: 99%

“…We could not identify all social complexity risk factors associated with use patterns in prior studies. 12,19,[23][24][25]27,[29][30][31] To be included in the initial cohort, children had to have an identifiable biologic parent and at least 1 month of Medicaid coverage during the study period, resulting in the exclusion of 13% of otherwise eligible children. In assessing the child's exposure to social risk in the context of their family and environment, we were limited to biologic parents.…”

mentioning

confidence: 99%

Using State Administrative Data to Identify Social Complexity Risk Factors for Children

Arthur¹,

Lucenko

Sharkova

et al. 2018

Ann Fam Med

View full text Add to dashboard Cite

PURPOSE Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. METHODSWe conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use. RESULTSNine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14).CONCLUSIONS State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children. 2018;16:62-69. https://doi.org/10.1370/afm.2134. Ann Fam Med INTRODUCTIONI n light of the strong evidence that exposure to social adversity in childhood is linked to poor child and adult health outcomes, 1-4 systematic strategies are needed to identify children at risk in order to provide appropriate referrals and services. Adverse childhood experiences, originally described by Felitti et al, 4 include family-related risk factors such as mental illness of a household member and exposure to abuse or neglect. There is a compelling case for identifying and addressing adverse childhood experiences and other social determinants of health at the family level because supporting parents is often the starting point for supporting children. 5Pediatric primary care interventions have successfully identified children with adverse childhood experiences or other social determinants of health, typically through parent report on a questionnaire. Subsequent intervention usually involves providing referrals to a social worker or appropriate community, hospital, or government programs, such as the Supplemental Nutrition Assistance Program, housing programs, utility bill assistance programs, transportation assistance, childcare providers, legal services, shelter arrangements, tax preparation support, or help in completing benefits forms ...

show abstract

“…58 Gaps act in a "dose-response" manner to inhibit access to care and increase unmet medical need-the longer the gap, the worse the problems with access. [59][60][61] Having stable, continuous insurance is associated with better access to health care and less unmet need, 11 but insurance alone is not a guarantee of access to health care. As recently reported, even privately-insured children do not get optimal quality health care up to 50% of the time.…”

Section: Discussionmentioning

confidence: 99%

Obtaining Health Care Services for Low-Income Children: A Hierarchy of Needs

DeVoe¹,

Graham²,

Angier³

et al. 2008

hpu

View full text Add to dashboard Cite

show abstract

When Insurance Status Is Not Static: Insurance Transitions of Low-Income Children and Implications for Health and Health Care

Cited by 39 publications

References 13 publications

The Association of Health Insurance and Continuous Primary Care in the Medical Home on Vaccination Coverage for 19- to 35-Month-Old Children

The Association of Health Insurance and Continuous Primary Care in the Medical Home on Vaccination Coverage for 19- to 35-Month-Old Children

Using State Administrative Data to Identify Social Complexity Risk Factors for Children

Obtaining Health Care Services for Low-Income Children: A Hierarchy of Needs

Contact Info

Product

Resources

About