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Health Care Costs and Financing

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Grandparents raising adolescent grandchildren often have trouble providing them with health insurance

The number of children living in households headed by a grandparent nearly doubled from 1970 to 1997 (from 2.2 to 3.9 million). In at least one-third of these households, neither parent was present. It is in these so-called skipped-generation families that grandparents are particularly hard-pressed to provide health insurance for their adolescent grandchildren compared with other types of families, according to James B. Kirby, Ph.D., of the Agency for Healthcare Research and Quality, and Toshiko Kaneda, Ph.D., of the Population Council.

In a recent study, they analyzed data collected in 1995 on the health insurance status of a large, nationally representative sample of 17,670 middle and high school students. They compared the health insurance status of adolescents in skipped-generation families with that of adolescents in two-parent families, single-mother families, and step-families (mother and stepfather). The researchers found that the heavy reliance of grandparents on public insurance over private insurance apparently was not due to their lack of work-related insurance because of retirement or more limited income than other family types.

Even after adjusting for work status, income, education, race/ethnicity, and sex, adolescents of skipped-generation families had a much greater mean predicted probability of having public insurance (.197) than adolescents of two-parent families, single-mother families, and step-families (.020, .061, and .041, respectively) and a lower mean predicted probability of being privately insured (.682 vs. .912, .842, and .858, respectively). All of the adolescents who lived outside of two-parent families were significantly more likely to have been uninsured than adolescents in two-parent families, with adolescents in skipped-generation families most likely to be uninsured.

More details are in "Health insurance and family structure: The case of adolescents in skipped-generation families," by Drs. Kirby and Kaneda, in the June 2002 Medical Care Research and Review 59(2), pp. 146-165.

Reprints (AHRQ Publication No. 02-R073) are available from the AHRQ Publications Clearinghouse.

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