Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. e751-e759 (doi:10.1542/peds.2005-1558)
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Enrolling Vulnerable, Uninsured but Eligible Children in Public Health Insurance: Association With Health Status and Primary Care Access

Gregory D. Stevens, PhDa, Michael Seid, PhDb and Neal Halfon, MD, MPHc

a Division of Community Health, Department of Family Medicine, University of Southern California Keck School of Medicine, Alhambra, California
b RAND Corporation, Santa Monica, California
c Center for Healthier Children, Families, and Communities, UCLA Schools of Medicine, Public Health, and Public Policy, Los Angeles, California

OBJECTIVES. Given that more than two thirds of uninsured children in California are eligible for public health insurance coverage, this study examined differences in primary care access and health status between uninsured but eligible (UBE) children and those who were insured.

METHODS. Using data on 19485 children from the 2001 California Health Interview Survey, this study examined differences in primary care access and health status for UBE children versus those who were enrolled in public coverage. Results are stratified by profiles of other risk factors (RF) for poor access: nonwhite, low income, low parent education, and non–English speaking.

RESULTS. UBE children were less likely than publicly enrolled children to have a physician visit in the past year, dental visit in the past year, and a regular source of care. On the basis of differences between the UBE children and enrollees in the prevalence of each dependent measure, UBE children with multiple RFs experienced greater disparities than UBE children with fewer RFs. For example, enrollees were more likely than UBE children to have a regular source of care among children with 2, 3, or 4 RFs (differences of 26, 26, and 25 percentage points, respectively) compared with 1 RF (19 percentage points) and 0 RFs (12 percentage points). A similar pattern was found for dental visits but not physician visits. Although there was no difference in health status between UBE children and enrollees overall, enrollees were more likely than UBE children to have excellent/very good health status among children with 2 RFs (difference of 9 percentage points), 3 RFs (12 percentage points), and 4 RFs (11 percentage points).

CONCLUSIONS. This study demonstrates that UBE children in California have poorer access to care compared with enrollees, and those with the highest levels of risk have poorer health status. This suggests that providing insurance to these children (and particularly those with multiple RFs) may lead to improved access and health for these vulnerable children.

Key Words: children • uninsured • Medicaid • State Children’s Health Insurance Program • primary care • access to care

Abbreviations: SES—socioeconomic status • RF—risk factor • CHI—children’s health initiative • UBE—uninsured but eligible • CHIS—California Health Interview Survey • FPL—federal poverty level • PR—prevalence ratio • CI—confidence interval

Accepted Sep 20, 2005.


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