based (private) insurance. They were four times more likely than children with private insurance or Medicaid to experience a delay seeking care because their parents were concerned about payment.

Health Insurance and Access to Care
Contacts with Physicians

The prevalence of both acute and chronic conditions among insured and uninsured children—and thus their needs for care—are similar (Holl et al., 1995). However, the amount of contact with physicians differs significantly.

Children without insurance coverage are more than twice as likely as insured children not to visit a physician over a 12-month period (Holl et al., 1995). A study based on the 1987 National Medical Expenditures Survey found that uninsured children received care for acute earaches, recurrent ear infections, pharyngitis, and asthma only half as often as children who had either public or private coverage (Stoddard et al., 1994).

We don't know very much about the transition to managed care, either in the public or private sectors. But in the fee-for-service world we have very good evidence that children who have Medicaid as a source of coverage have utilization patterns and sources of care that look like those for children with private insurance.

Kay Johnson

George Washington University, Washington, DC

Public Workshop, June 2, 1997

Uninsured children with chronic medical conditions also have been found to have insufficient access to routine medical care. According to a national survey sponsored by the Robert Wood Johnson Foundation, nearly one in five uninsured children (17 percent) did not receive medical treatment needed for a chronic illness such as asthma, diabetes, or other conditions (32 percent) serious enough to keep a child from functioning at school (Wood et al., 1990).

Medical Attention for Injuries

Uninsured children are less likely than those with insurance to receive medical care for injuries, even for serious injuries. Among children who are uninsured, one study found that as many as 30 percent of all children with injuries and 40 percent of all children with serious injuries may not receive medical attention (Overpeck and Kotch, 1995). Injured children with Medicaid coverage and children with private insurance were found to have comparable access to medical attention (Overpeck and Kotch, 1995), which is consistent with the findings about access to medical services in other studies (Butler et al., 1985; St. Peter et al., 1992).

Hospital Services

Insured children have been found to have better outcomes from hospitalizations than uninsured children. Among children hospitalized in New York City for similar problems, one study found an in-



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