PEDIATRICS Vol. 79 No. 1 January 1987, pp. 89-98
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Health Insurance Coverage and Physician Use Among Children With Disabilities: Findings From Probability Samples in Five Metropolitan Areas

John A. Butler EdD1, Judith D. Singer PhD1, Judith S. Palfrey MD1, and Deborah K. Walker EdD1

1 From the Division of Health Policy Research and Education, Harvard Medical School, and the Children's Hospital, Boston

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that (1) health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P < .05); (2) Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P < .001), but there was no similar statistically significant difference between blacks and whites; and (3) wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various lowprevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

Key Words: health insurance • physician use • disabled children

Submitted on January 22, 1986
Accepted on April 4, 1986




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