 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 Institute for Health Policy Studies, Department of Pediatrics, University of California, San Francisco
2 Institute for Health Policy Studies University of California, San Francisco
3 Department of Pediatrics, University of Wisconsin Medical School, Madison
Objective. Congressional initiatives to reduce spending under major public programs designed to improve access to health care have brought renewed attention to the health care needs of traditionally disadvantaged populations. The objective of this study was to assess access to and use of primary care services for poor, minority, and uninsured children in the United States.
Design and Setting. We analyzed data on 7578 1-to 17-year-old children of families responding to the 1987 National Medical Expenditure Survey, a nationally representative sample of families and children.
Outcome Measures. Adult respondents were asked to report on several measures of access and use of care for children in the household. These included the presence of a usual source of care and its characteristics (type of site, travel time, waiting time, after-hours care, and availability of a regular physician). We also examined the volume of physician contacts relative to the sample child's health status, the receipt of measles vaccinations, and whether children received care in response to selected symptoms of ill health. Results are presented for children generally and for four subgroups: poor children; minority children; uninsured children; and white, nonpoor, or, insured childrn (the reference group).
Results. Poor, minority, and uninsured children fared consistently worse than the children in the reference group on all indicators studied. For example, children in each of the three at-risk groups were twice as likely as the children in the reference group to lack usual sources of care, nearly twice as likely to wait 60 minutes or more at their sites of care, and used only about half as many physician services after adjusting for health status. Multivariate analyses revealed that poverty, minority status, and absence of insurance exert independent effects on access to and use of primary care.
Conclusions. The existence of substantial barriers to the access to and use of primary care for low-income, minority, and uninsured children is cause for significant concern, especially in an era of program cutbacks. New initiatives are needed to address both financial and nonfinancial barriers to the receipt of primary care for disenfranchised children.
Submitted on August 23, 1994
This article has been cited by other articles:
 |
|
 |
|
  C. J. Wang, M. N. Elliott, E. A. McGlynn, R. H. Brook, and M. A. Schuster Population-Based Assessments of Ophthalmologic and Audiologic Follow-up in Children With Very Low Birth Weight Enrolled in Medicaid: A Quality-of-Care Study Pediatrics, February 1, 2008; 121(2): e278 - e285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Perry and G. M. Kenney Preventive Care for Children in Low-Income Families: How Well Do Medicaid and State Children's Health Insurance Programs Do? Pediatrics, December 1, 2007; 120(6): e1393 - e1401. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. DeVoe, A. Baez, H. Angier, L. Krois, C. Edlund, and P. A. Carney Insurance + Access != Health Care: Typology of Barriers to Health Care Access for Low-Income Families Ann. Fam. Med, November 1, 2007; 5(6): 511 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N.-A. M. Molinari, M. Kolasa, M. L. Messonnier, and R. A. Schieber Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of Insurance Plan Pediatrics, November 1, 2007; 120(5): e1148 - e1156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Federico, J. F. Steiner, B. Beaty, L. Crane, and A. Kempe Disruptions in Insurance Coverage: Patterns and Relationship to Health Care Access, Unmet Need, and Utilization Before Enrollment in the State Children's Health Insurance Program Pediatrics, October 1, 2007; 120(4): e1009 - e1016. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Zebracki and T. Stancin Cultural Considerations in Facilitating Coping to a Father's Illness and Bereavement in a Latino Child Clinical Case Studies, February 1, 2007; 6(1): 3 - 16. [Abstract] [PDF]
|
|
|
|
|
|
M. B. Zeni, W. Sappenfield, D. Thompson, and H. Chen Factors Associated With Not Having a Personal Health Care Provider for Children in Florida Pediatrics, February 1, 2007; 119(Supplement_1): S61 - S67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Hambidge, C. B. Emsermann, S. Federico, and J. F. Steiner Disparities in Pediatric Preventive Care in the United States, 1993-2002 Arch Pediatr Adolesc Med, January 1, 2007; 161(1): 30 - 36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Flores, M. Abreu, and S. C. Tomany-Korman Why Are Latinos the Most Uninsured Racial/Ethnic Group of US Children? A Community-Based Study of Risk Factors for and Consequences of Being an Uninsured Latino Child Pediatrics, September 1, 2006; 118(3): e730 - e740. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Wang, E. A. McGlynn, R. H. Brook, C. H. Leonard, R. E. Piecuch, S. I. Hsueh, and M. A. Schuster Quality-of-Care Indicators for the Neurodevelopmental Follow-up of Very Low Birth Weight Children: Results of an Expert Panel Process. Pediatrics, June 1, 2006; 117(6): 2080 - 2092. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Stevens, M. Seid, and N. Halfon Enrolling Vulnerable, Uninsured but Eligible Children in Public Health Insurance: Association With Health Status and Primary Care Access Pediatrics, April 1, 2006; 117(4): e751 - e759. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Biondich, S. M. Downs, A. E. Carroll, A. L. Laskey, G. C. Liu, M. Rosenman, J. Wang, and N. L. Swigonski Shortcomings in Infant Iron Deficiency Screening Methods Pediatrics, February 1, 2006; 117(2): 290 - 294. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Flores, M. Abreu, C. E. Chaisson, A. Meyers, R. C. Sachdeva, H. Fernandez, P. Francisco, B. Diaz, A. M. Diaz, and I. Santos-Guerrero A Randomized, Controlled Trial of the Effectiveness of Community-Based Case Management in Insuring Uninsured Latino Children Pediatrics, December 1, 2005; 116(6): 1433 - 1441. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Satchell and S. Pati Insurance Gaps Among Vulnerable Children in the United States, 1999-2001 Pediatrics, November 1, 2005; 116(5): 1155 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Starfield Insurance and the U.S. Health Care System N. Engl. J. Med., July 28, 2005; 353(4): 418 - 419. [Full Text] [PDF]
|
|
|
|
|
|
L. P. Shone, A. W. Dick, J. D. Klein, J. Zwanziger, and P. G. Szilagyi Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program Pediatrics, June 1, 2005; 115(6): e697 - e705. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Hargunani Healthcare Coverage for Children: Are We Making Progress? AAP Grand Rounds, April 1, 2005; 13(4): 46 - 46. [Full Text] [PDF]
|
|
|
|
|
|
R. Hoekelman Commentary: Pre-Primary Care Pediatrics Pediatrics, April 1, 2005; 115(4/S1): 1148 - 1149. [Full Text] [PDF]
|
|
|
|
|
|
C. A. James, F. T. Bourgeois, and M. W. Shannon Association of Race/Ethnicity with Emergency Department Wait Times Pediatrics, March 1, 2005; 115(3): e310 - e315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Zito, D. J. Safer, I. H. Zuckerman, J. F. Gardner, and K. Soeken Effect of Medicaid Eligibility Category on Racial Disparities in the Use of Psychotropic Medications Among Youths Psychiatr Serv, February 1, 2005; 56(2): 157 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Buetow Distributed Decisions: The Example of Child Access to Primary Health Care Sociology, February 1, 2005; 39(1): 107 - 120. [Abstract] [PDF]
|
|
|
|
 |
|
 P. A. Braveman, S. A. Egerter, C. Cubbin, and K. S. Marchi An Approach to Studying Social Disparities in Health and Health Care Am J Public Health, December 1, 2004; 94(12): 2139 - 2148. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Mackie, K. Gauvreau, J. W. Newburger, J. E. Mayer, and L. C. Erickson Risk Factors for Readmission After Neonatal Cardiac Surgery Ann. Thorac. Surg., December 1, 2004; 78(6): 1972 - 1978. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Mainous III, D. E. King, D. R. Garr, and W. S. Pearson Race, Rural Residence, and Control of Diabetes and Hypertension Ann. Fam. Med, November 1, 2004; 2(6): 563 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. W. Dick, C. Brach, R. A. Allison, E. Shenkman, L. P. Shone, P. G. Szilagyi, J. D. Klein, and E. M. Lewit SCHIP's Impact In Three States: How Do The Most Vulnerable Children Fare? Health Aff., September 1, 2004; 23(5): 63 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Boyle, R. R. Baker, and V. H. Kemp School-Based Asthma: A Study in an African American Elementary School J Transcult Nurs, July 1, 2004; 15(3): 195 - 206. [Abstract] [PDF]
|
|
|
|
|
|
J. M. Santoli, N. J. Huet, P. J. Smith, L. E. Barker, L. E. Rodewald, M. Inkelas, L. M. Olson, and N. Halfon Insurance Status and Vaccination Coverage Among US Preschool Children Pediatrics, June 1, 2004; 113(6/S1): 1959 - 1964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Shields, C. Comstock, and K. B. Weiss Variations in Asthma Care by Race/Ethnicity Among Children Enrolled in a State Medicaid Program Pediatrics, March 1, 2004; 113(3): 496 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Randolph, M. Murray, J. A. Swanson, and P. A. Margolis Behind Schedule: Improving Access to Care for Children One Practice at a Time Pediatrics, March 1, 2004; 113(3): e230 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Haas, L. B. Lee, C. P. Kaplan, D. Sonneborn, K. A. Phillips, and S.-Y. Liang The Association of Race, Socioeconomic Status, and Health Insurance Status With the Prevalence of Overweight Among Children and Adolescents Am J Public Health, December 1, 2003; 93(12): 2105 - 2110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Shone, A. W. Dick, C. Brach, K. S. Kimminau, B. J. LaClair, E. A. Shenkman, J. F. Col, V. A. Schaffer, F. Mulvihill, P. G. Szilagyi, et al. The Role of Race and Ethnicity in the State Children's Health Insurance Program (SCHIP) in Four States: Are There Baseline Disparities, and What Do They Mean for SCHIP? Pediatrics, December 1, 2003; 112(6): e521 - 532. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. L. Young and C. Ireson Effectiveness of School-Based Telehealth Care in Urban and Rural Elementary Schools Pediatrics, November 1, 2003; 112(5): 1088 - 1094. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Smith, J. M.H. Risser, L. D. Lisabeth, L. A. Moye, and L. B. Morgenstern Access to Care, Acculturation, and Risk Factors for Stroke in Mexican Americans: The Brain Attack Surveillance in Corpus Christi (BASIC) Project Stroke, November 1, 2003; 34(11): 2671 - 2675. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Richardson, D. DiGiuseppe, M. Garrison, and D. A. Christakis Depression in Medicaid-Covered Youth: Differences by Race and Ethnicity Arch Pediatr Adolesc Med, October 1, 2003; 157(10): 984 - 989. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Elster, J. Jarosik, J. VanGeest, and M. Fleming Racial and Ethnic Disparities in Health Care for Adolescents: A Systematic Review of the Literature Arch Pediatr Adolesc Med, September 1, 2003; 157(9): 867 - 874. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Drukker, S. Feinstein, C. Rinat, A. Rotem-Braun, and Y. Frishberg Cadaver-Donor Renal Transplantation of Children in Israel (1990-2001): Racial Disparities in Health Care Delivery? Pediatrics, August 1, 2003; 112(2): 341 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Woods, T. A. Arcury, J. M. Powers, J. S. Preisser, and W. M. Gesler Determinants of Health Care Use by Children in Rural Western North Carolina: Results From the Mountain Accessibility Project Survey Pediatrics, August 1, 2003; 112(2): e143 - 152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Stevens, L. Shi, and L. A. Cooper Patient-Provider Racial and Ethnic Concordance and Parent Reports of the Primary Care Experiences of Children Ann. Fam. Med, July 1, 2003; 1(2): 105 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. E. El-Mohandes, K. S. Katz, M. N. El-Khorazaty, D. McNeely-Johnson, P. W. Sharps, M. H. Jarrett, A. Rose, D. M. White, M. Young, L. Grylack, et al. The Effect of a Parenting Education Program on the Use of Preventive Pediatric Health Care Services Among Low-Income, Minority Mothers: A Randomized, Controlled Study Pediatrics, June 1, 2003; 111(6): 1324 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Mansour, U. Kotagal, B. Rose, M. Ho, D. Brewer, A. Roy-Chaudhury, R. W. Hornung, T. J. Wade, and T. G. DeWitt Health-Related Quality of Life in Urban Elementary Schoolchildren Pediatrics, June 1, 2003; 111(6): 1372 - 1381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Reeher Reform and Remembrance: The Place of the Private Sector in the Future of Health Care Policy Journal of Health Politics Policy and Law, April 1, 2003; 28(2-3): 355 - 386. [Abstract] [PDF]
|
|
|
|
 |
|
 G. D. Stevens and L. Shi Racial and Ethnic Disparities in the Primary Care Experiences of Children: A Review of the Literature Med Care Res Rev, March 1, 2003; 60(1): 3 - 30. [Abstract] [PDF]
|
|
|
|
|
|
A. H. Schempf, R. M. Politzer, and J. Wulu Immunization Coverage of Vulnerable Children: A Comparison of Health Center and National Rates Med Care Res Rev, March 1, 2003; 60(1): 85 - 100. [Abstract] [PDF]
|
|
|
|
|
|
S. H. Zuvekas and G. S. Taliaferro Pathways To Access: Health Insurance, The Health Care Delivery System, And Racial/Ethnic Disparities, 1996-1999 Health Aff., March 1, 2003; 22(2): 139 - 153. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T. Slifkin, V. A. Freeman, and P. Silberman Effect of the North Carolina State Children's Health Insurance Program on Beneficiary Access to Care Arch Pediatr Adolesc Med, December 1, 2002; 156(12): 1223 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Yu, H. A. Bellamy, M. D. Kogan, J. L. Dunbar, R. H. Schwalberg, and M. A. Schuster Factors That Influence Receipt of Recommended Preventive Pediatric Health and Dental Care Pediatrics, December 1, 2002; 110(6): e73 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Bierman, N. Lurie, K. S. Collins, and J. M. Eisenberg Addressing Racial And Ethnic Barriers To Effective Health Care: The Need For Better Data Health Aff., May 1, 2002; 21(3): 91 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Edwards, J. Bronstein, and D. B. Rein Do Enrollees In 'Look-Alike' Medicaid And SCHIP Programs Really Look Alike? Health Aff., May 1, 2002; 21(3): 240 - 248. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. H. Park, M. D. Kogan, M. D. Overpeck, and M. L. Casselbrant Black-White Differences in Health Care Utilization Among US Children With Frequent Ear Infections Pediatrics, May 1, 2002; 109(5): e84 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Halldorsson, A E Kunst, L Kohler, and J P Mackenbach Socioeconomic differences in children's use of physician services in the Nordic countries J. Epidemiol. Community Health, March 1, 2002; 56(3): 200 - 204. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. McNulty, L. C. Hampers, and S. E. Krug Primary Care and Emergency Department Decision Making Arch Pediatr Adolesc Med, November 1, 2001; 155(11): 1266 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Racine, R. Kaestner, T. J. Joyce, and G. J. Colman Differential Impact of Recent Medicaid Expansions by Race and Ethnicity Pediatrics, November 1, 2001; 108(5): 1135 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. B. Hakim and B. V. Bye Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries Pediatrics, July 1, 2001; 108(1): 90 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Alessandrini, K. N. Shaw, W. B. Bilker, K. A. Perry, M. D. Baker, and D. F. Schwarz Effects of Medicaid Managed Care on Health Care Use: Infant Emergency Department and Ambulatory Services Pediatrics, July 1, 2001; 108(1): 103 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Guendelman and M. Pearl Access to Care for Children of the Working Poor Arch Pediatr Adolesc Med, June 1, 2001; 155(6): 651 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Alessandrini, K. N. Shaw, W. B. Bilker, D. F. Schwarz, and L. M. Bell Effects of Medicaid Managed Care on Quality: Childhood Immunizations Pediatrics, June 1, 2001; 107(6): 1335 - 1342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. I. Fisch Insurance and Education Are the Principal Determinants of Survival in Infantile Aortic Coarctation AAP Grand Rounds, March 1, 2001; 5(3): 25 - 25. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Guevara, J. C. C. Young, and B. A. Mueller Do Protective Factors Reduce the Risk of Hospitalization in Infants of Teenaged Mothers? Arch Pediatr Adolesc Med, January 1, 2001; 155(1): 66 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Weinick, S. H. Zuvekas, and J. W. Cohen Racial and Ethnic Differences in Access to and Use of Health Care Services, 1977 to 1996 Med Care Res Rev, December 1, 2000; 57(4_suppl): 36 - 54. [Abstract] [PDF]
|
|
|
|
|
|
