Narrowing disparities in access to healthcare among children

1. Using a nationally representative sample of almost 200 000 children, trends in health insurance and access to care were analyzed. Overall, uninsured rates declined from 12.1% in 2000 to 5.3% in 2014, and there was overall increase in access to care.

2. Hispanic and black children had the most sizable improvement in access indicators and prevalence of insured children, as did children in poor and near-poor families.

Study Rundown: Access to healthcare and insurance in childhood has long-term effects, including improved health outcomes in adulthood. Recent policy initiatives have focused on improving healthcare coverage for children, but few studies have comprehensively assessed the effect of these policies. This study is one of few to comprehensively assess trends in insurance and access to care among children in the United States. Access indicators were: having a well-child visit, seeing a doctor in an office setting, having a dental visit, having a usual source of care, and having unmet healthcare needs. Overall, uninsured rates decreased by over half from 2000 to 2014, with an increase in public insurance and decrease in private insurance utilization. Hispanic children had the highest improvement in not seeing a doctor, not having a dental visit, and not having a usual source of care. Black children, and children of poor and near-poor families also had significantly improved access to care and rates of insurance. Hispanic and black children’s access to care neared or reached that of white children, effectively narrowing the disparity among multiple access indicators. Though this study provides comprehensive insight, it is limited by reliance on parent report of child healthcare utilization. Nonetheless, these findings create a case for pediatricians and other stakeholders to advocate for continued state funding of programs such as Medicaid and CHIP in order to continue improving children’s access to care.

Click to read the study published today in Pediatrics

Relevant Reading: Access to care and utilization among children: estimating the effects of public and private coverage

In-Depth [cross-sectional study]: This study included 178 038 children ages 0 to 17 years from 2000 to 2014, whose families participated in the National Health Interview Survey. Access to health was analyzed using 5 access indicators, including if there was a well-child check, a doctor’s office visit, and a dental visit in the last year, if the parent had a usual source of care (medical home) for the child, and if there were unmet healthcare needs. Children were characterized as poor (<100% of federal poverty level [FPL]), near-poor (100-199% FPL) and not poor (>200% FPL). The uninsured rate went from 12.1% in 2000 to 5.3% in 2015 (P < .05), which translated to coverage of an additional 4.9 million children. The uninsured rate for Hispanic children went from 26.1% to 9.3%, a decline of 64%, while rates for black children declined 72% (11.7% to 3.3%), which approached and eliminated the gap versus white children, respectively. Children of poor and near-poor families showed steeper decline as well (22.2% to 5.9% and 21.2% to 8.8%, respectively). There was a significant decline in rates for no well-child visit (29.0% to 16.2%), no doctor office visit (12.9% to 8.6%), no dental visit (29.6% to 20.7%), no usual source of care (7.0% to 3.6%), and unmet health care needs (7.9% to 5.8%, P < .05 for all). The greatest improvements to access were seen among Hispanic and black children, and steeper improvements were seen among poor and near-poor families, resulting in a narrowing of disparities compared to not poor and white children.

Image: PD

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