America's Children Health Insurance and Access to Care (1998) / Chapter Skim
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3 Health Insurance and Access to Care
3 Health Insurance and Access to Care
Pages 44-64
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From page 44... ...
This chapter begins with a general discussion of the evidence that health insurance affects chilciren's access to health care, emphasizing differences in health care utilization rates for insured anc3 uninsured chilclren. Next, other financial and nonfinancial barriers to care are cliscussecl, including family income; family structure; anc3 racial, ethnic, anc3 cultural factors.
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From page 45... ...
45 E o ~ o ;;: E _ o .o ._ ~ In · ._ Q O ~._ Q ~ o Q us In .
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According to a national survey sponsored by the Robert Wood Johnson Foundation, nearly one in five uninsured children (17 percent) clic3 not receive medical treatment neeciec3 for a chronic illness such as asthma, diabetes, or other conditions (32 percent)
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From page 47... ...
They don't enjoy it, and you wouldn't enjoy it either. James Bentley American Hospital Association, Washington, DC Public Workshop June 2, ~ 997 Preventive Care Insured children are much more likely to have a usual provider for routine preventive services anc3 to receive recommenclec3 anc3 age-appropriate services (Holl et al., 1995; Kogan et al., 1995~.
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From page 48... ...
Condition Low-lncome Areas High-lncome Areas Bacterial pneumonia 11.21 2.78 Asthma 11.1 2 2.55 Gastroenteritis 5.67 2.10 Dehydration 5.61 3.01 Severe ear/nose/throat infections 5.04 1.21 Kidney/urinary infection 1.91 0.78 Iron deficiency anemia 1.02 0.14 NOTE: Data are from 10 states having a total population of 95 million. High-income areas are zip codes in which fewer than 15 percent of households have annual incomes below $15,000; low-income areas are zip codes in which 50 percent or more of households have annual incomes below $15,000.
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From page 49... ...
Data are from the National Health Interview Survey, supplemented by information collected from vaccination providers in the National Immunization Provider Record Check study. NOTES: Poverty status is based on family income and family size using Bureau of the Census poverty thresholds (see Chapter 2, Table 2.5 in this report)
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From page 50... ...
In the mic3-1980s, the RAND Health Insurance Experiment found that reclucec3 cost-sharing for dental services led to increased use of preventive dental services as well as significantly fewer ciecayec3 teeth (Isman, 1997; Newhouse et al., 19931. It is well established that inclivicluals who have private dental insurance are more likely to use dental services, including preventive services, than those who are uninsured (Bloom et al., 1992; Newacheck et al., 1997~.
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SOURCE: NCHS (1997b, pp.4, 6~. Data are from the 1995 National Hospital Ambulatory Medical Care Survey, Emergency Department Summary.
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For thirty or forty years, we have known that if you really want to change health status, the su refire way to do it is to increase personal disposable income, improve education, improve nutrition, and make sure people have safe and affordable housing. From a public health perspective, direct access to health care services would come in fifth.
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From page 53... ...
A study of African Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites in poor areas of Chicago found that African Americans tended to use hospital-based facilities, while Mexican Americans were the least likely of all the groups to have a regular source of care, in large part because of social and cultural barriers such as language and immigration status (Lewin-Epstein, 1991~. Hispanics with traditional health beliefs and ~ ~ ~ .
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From page 54... ...
For example, after barriers to care were reclucec3 through 24-hour availability of care anc3 limiting the waiting time for appointments, a Baltimore study found that the use of health care became more comparable for black anc3 white children (Orr et al., 1984, 1988~. Similarly, when language anc3 income barriers were minimized, urban Mexican American anc3 white elementary~school children no longer clifferec3 in their use of health care services (Gilman anc3 Bruhn, 19811.
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~.~ ~ ~ ACCESS TO WHAT? DEFINING NECESSARY HEALTH SERVICES As a matter of principle, the committee believes that all children should have appropriate access to coordinated, effective, and child- appropriate care, including the following health care services: · generally accepted preventive services for health promotion and disease prevention (anticipatory guidance, health supervision, or maintenance)
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From page 56... ...
Although children who are uninsured have less access to care, it is important to recognize that the presence of insurance alone will not eliminate all of the barriers to accessing appropriate health care services. Children are ciepencient on their parents to identify problems anc3 seek treatment, anc3 even insured anc3 responsible parents may delay seeking care because of the cost of the out~of~pocket expenses or because it is difficult or inconvenient to schedule appointments.
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From page 57... ...
SOURCE: Data are from the National Health Interview Survey, NCHS, 1997. Adapted from HIM (1997, p.
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From page 62... ...
1995. Profile of Uninsured Children in the United States.
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From page 63... ...
1997b. National Hospital Ambulatory Medical Care Survey: 1995, Emergency Department Summary.
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From page 64... ...
Public Health Reports 197:544-548. United States Preventive Services Task Force.
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