TY - JOUR
T1 - Access to care, unmet health needs, and poverty status among children with and without chronic conditions
AU - Silver, Ellen Johnson
AU - Stein, Ruth E.K.
N1 - Funding Information:
This work was supported by a Data Utilization and Enhancement Grant (MCJ-36D257) from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. All analyses, interpretations, or conclusions derived from these data are the responsibility of the authors and not the National Center for Health Statistics, which is responsible only for the quality of the data set.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2001
Y1 - 2001
N2 - Objectives. - To compare insurance coverage, access to care, and unmet health needs of children with and without chronic conditions in a national probability sample of the US population and to examine the role of poverty status in any demonstrated differences between the 2 groups. Design. - We analyzed parent-report data on children 0-17 years old from the 1994 National Health Interview Survey Disability Supplement (NHIS-D) and from the health insurance and access to care files of the 1994 Family Resources Supplement to the NHIS. In the NHIS-D, 4452 (14.8%) of the 30032 children were identified as having a chronic condition by a noncategorical method. We compared insurance coverage, access to care, and unmet needs of children with and without conditions overall and also compared them within 3 different income levels relative to the national poverty index: 1) below, 2) within 100%-200%, and 3) >200% above poverty level. Results. - In bivariate analyses, children with chronic conditions were more likely to be covered by some type of health insurance (odds ratio [OR], 1.3) and to have a usual provider both for medical ("sick") care (OR, 1.4) and for routine or preventive care (OR, 1.4). They also were more likely to have the same provider for medical care and routine or preventive care (OR, 1.2) and to have seen their health care provider in the last year (OR, 1.8) than children without chronic conditions (all P < .0001). Nonetheless, children with chronic conditions were twice as likely to have had at least 1 unmet need from a list of 4 services that included dental care, prescription medications, eyeglasses, and mental health services (OR, 2.0). They also were more likely to have more than 1 unmet need from the list (OR, 3.1), to have been unable to get needed medical care (OR, 3.1), and to have delayed obtaining medical care because of worry about its cost (OR, 1.8). Children with chronic conditions were at greater risk for unmet needs than were children without conditions across all income levels. The magnitude of the disparity between the groups increased with family income level. Differences persisted even after controlling for sociodemographic variables and insurance status. Conclusion. - Despite higher levels of insurance coverage and greater access to regular providers of medical and routine care compared with healthy peers, children with chronic conditions are reported by their parents to be less likely than other children to receive the full range of needed health services. The magnitudes of the differences are small, yet the pattern of disadvantage in meeting health care needs among children with conditions compared with healthy peers is consistent across many different variables and it exists across income levels.
AB - Objectives. - To compare insurance coverage, access to care, and unmet health needs of children with and without chronic conditions in a national probability sample of the US population and to examine the role of poverty status in any demonstrated differences between the 2 groups. Design. - We analyzed parent-report data on children 0-17 years old from the 1994 National Health Interview Survey Disability Supplement (NHIS-D) and from the health insurance and access to care files of the 1994 Family Resources Supplement to the NHIS. In the NHIS-D, 4452 (14.8%) of the 30032 children were identified as having a chronic condition by a noncategorical method. We compared insurance coverage, access to care, and unmet needs of children with and without conditions overall and also compared them within 3 different income levels relative to the national poverty index: 1) below, 2) within 100%-200%, and 3) >200% above poverty level. Results. - In bivariate analyses, children with chronic conditions were more likely to be covered by some type of health insurance (odds ratio [OR], 1.3) and to have a usual provider both for medical ("sick") care (OR, 1.4) and for routine or preventive care (OR, 1.4). They also were more likely to have the same provider for medical care and routine or preventive care (OR, 1.2) and to have seen their health care provider in the last year (OR, 1.8) than children without chronic conditions (all P < .0001). Nonetheless, children with chronic conditions were twice as likely to have had at least 1 unmet need from a list of 4 services that included dental care, prescription medications, eyeglasses, and mental health services (OR, 2.0). They also were more likely to have more than 1 unmet need from the list (OR, 3.1), to have been unable to get needed medical care (OR, 3.1), and to have delayed obtaining medical care because of worry about its cost (OR, 1.8). Children with chronic conditions were at greater risk for unmet needs than were children without conditions across all income levels. The magnitude of the disparity between the groups increased with family income level. Differences persisted even after controlling for sociodemographic variables and insurance status. Conclusion. - Despite higher levels of insurance coverage and greater access to regular providers of medical and routine care compared with healthy peers, children with chronic conditions are reported by their parents to be less likely than other children to receive the full range of needed health services. The magnitudes of the differences are small, yet the pattern of disadvantage in meeting health care needs among children with conditions compared with healthy peers is consistent across many different variables and it exists across income levels.
KW - Access to care
KW - Children
KW - Chronic health conditions
KW - Health insurance
KW - Poverty
KW - Unmet needs
KW - Utilization
UR - http://www.scopus.com/inward/record.url?scp=0035525558&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035525558&partnerID=8YFLogxK
U2 - 10.1367/1539-4409(2001)001<0314:ATCUHN>2.0.CO;2
DO - 10.1367/1539-4409(2001)001<0314:ATCUHN>2.0.CO;2
M3 - Article
C2 - 11888421
AN - SCOPUS:0035525558
SN - 1530-1567
VL - 1
SP - 314
EP - 320
JO - Ambulatory Pediatrics
JF - Ambulatory Pediatrics
IS - 6
ER -