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Efforts beyond expanding health coverage may be needed to improve access and quality for low-income and minority children

Lisa Simpson, M.B., B.Ch., M.P.H., former Deputy Director of the Agency for Healthcare Research and Quality and now with the Department of Pediatrics at the University of South Florida, and her colleagues from AHRQ and the Harvard School of Public Health recently published the fifth in a series of reports analyzing patterns of coverage, use of health services, quality, and expenditures for the Nation's children aged 0 to 17.

Dr. Simpson and her colleagues found that, for example, children from low-income families were more likely than children from middle- to high-income families to be uninsured (13 vs. 5.8 percent) or covered by public insurance (50.8 vs. 7.3 percent), and they were less likely to be privately insured (36.2 vs. 87 percent). Children from low-income families were also less likely to have had a medical office visit (63.7 vs. 76.5 percent) or dental visit (28.8 vs. 51.4 percent), to have medicines prescribed (45.1 vs. 56.4 percent), or to have used hospital outpatient services (5.2 vs. 7 percent) in a year.

On the other hand, low-income youth are more likely to have made trips to the emergency department (14.6 vs. 11.4 percent) and to have been hospitalized for conditions that usually can be managed with good outpatient care. Low-income children were more likely than middle- to high-income children to have their parents report significant problems in getting necessary care (2.4 vs. 1 percent), getting a referral to a specialist (11.5 vs. 5.3 percent), and communicating with physicians. Regardless of income, black children had lower health care use and expenditures than white children.

Although low-income children account for nearly 40 percent of the U.S. child population, only one-quarter of total medical expenditures are for these children. Expanding health insurance coverage alone may not be enough to improve care access and quality for low-income children overall and for minority children regardless of income, conclude the researchers. Their findings are based on an analysis of data from the 2000-2002 Medical Expenditure Panel Survey and the 2001 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project.

See "Health care for children and youth in the United States: Annual report on patterns of coverage, utilization, quality, and expenditures by income," by Dr. Simpson, Pamela L. Owens, Ph.D., Marc W. Zodet, M.S., and others, in the Jan/Feb 2005 Ambulatory Pediatrics 5(1), pp. 6-44, 2005. Reprints (AHRQ Publication No. 05-R048) are available from the AHRQ Publications Clearinghouse.

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