PEDIATRICS Vol. 91 No. 5 May 1993, pp. 1040-1047
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Health Insurance Differentials Among Minority Children With Chronic Conditions and the Role of Federal Agencies and Private Foundations in Improving Financial Access

Margaret A. McManus MHS1 and Paul Newacheck DrPH2

1 From McManus Health Policy, Inc, Washington, DC
2 From Institute for Health Policy Studies, School of Medicine, University of California, San Francisco

Minorities experience a disproportionate share of the financial barriers resulting from higher rates of uninsuredness and a greater reliance on Medicaid vs private insurance. As a result, health services use and patterns of expenditures vary markedly by race and ethnicity.1,2

National survey data reveal a rapid increase in the number of uninsured black and Hispanic persons between 1977 and 1987.3 The major factors contributing to this increase are (1) overall growth in the size of the minority population, especially Hispanics; (2) reductions in private insurance coverage; and (3) the lack of significant expansions in public programs, largely Medicaid (note: several Medicaid eligibility expansions affecting poor children occurred during and after 1987).

In 1987, 14% of white children younger than age 18 were uninsured compared to 22% of black children and 33% of Hispanic children (Cornelius LJ. Unpublished data). Black and Hispanic persons were more likely to rely on Medicaid as their primary financing source than were white persons.3 In 1987, 8% of white children were covered by Medicaid vs 38% of black and 28% of Hispanic children (Cornelius LJ. Unpublished data from the Agency for Health Care Policy and Research, 1992.). Despite Medicaid's importance as a financing source, low reimbursement rates have resulted in inadequate provider participation and corresponding access barriers.4,5

In comparison with white persons, minorities have less access to employer-based insurance benefits. Part of the reason lies in the types of jobs that are disproportionately held by minorities. Personal service and agricultural employers typically do not offer health insurance to their employees.




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M. E. Brown, A. B. Bindman, and N. Lurie
Monitoring the Consequences of Uninsurance: A Review of Methodologies
Med Care Res Rev, June 1, 1998; 55(2): 177 - 210.
[Abstract] [PDF]