Abstract:
Background Past studies have typically focused on the effect of health insurance on primary health care for children, but few have assessed the effect the type of health insurance coverage has on primary care. This research studied the effect of health insurance status—uninsured, private insurance, public coverage, or other insurance—on the accessibility, continuity, and comprehensiveness of primary health care for children.
Methods This research analyzed a sample of 39,225 children under 18 years of age from the 2006-2009 National Health Interview Survey, a nationally representative sample of households in the United States. The response rate for children was 75.2 percent. Logistic regression models were used to analyze the effect of health insurance on health status and three aspects of primary care: accessibility (physician visit; usual source of care; time since health professional visit), continuity, (usual source and site of care), and comprehensiveness (physical). Excellent or very good health status was the final dependent variable.
Results Compared to children with private health insurance, uninsured children and Medicaid or State Children’s Health Insurance Program (SCHIP) beneficiaries are 27% (p<0.001) and 89.4% (p<0.01) as likely, respectively, to have visited a physician within the last twelve months (LTM). Approximately 73% of uninsured children reported having a usual source of care, compared to 96% of children with private insurance and 98% of Medicaid/SCHIP beneficiaries. Children with private health insurance are at least twice as likely to report “excellent or very good” health as children with any other health insurance status (p<0.001). After controlling for the confounding effects of age, citizenship, mother’s education, father’s education, health status, poverty status, race/ethnicity, and region, Medicaid/SCHIP coverage is associated with similar, if not better, accessibility, continuity, and comprehensiveness of primary care compared to children with private insurance.
Conclusions Although by many indicators Medicaid and SCHIP enrollees have worse primary care than children with private health insurance, Medicaid and SCHIP beneficiaries are more likely to have risk factors that are associated with poorer primary care and poorer child health status. Nevertheless, clear relationships cannot be established to conclude how government health insurance programs perform relative to private insurance. Health insurance status is an important predictor, but not the only predictor, of the accessibility, continuity, and comprehensiveness of primary care. Other important risk factors include adolescence, non-U.S. citizenship, low levels of mother’s education, poverty, and residence in the West or South.
