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Children with private insurance have better access to specialty care than those with public and no insurance

Uninsured children have less access to specialty care than publicly insured children who, in turn, have less access to specialty care than children who are privately insured. It is not clear which structure of insurance leads to the best use of appropriate specialty care by children, conclude University of North Carolina researchers, Asheley Cockrell Skinner, Ph.D., and Michelle L. Mayer, R.N., M.P.H., Ph.D. They reviewed 30 studies on the topic, which measured access as number of specialty visits or referrals to specialists. The studies on uninsured children found that they used less specialty care and experienced greater delays in referrals to specialists than insured children.

The lack of insurance may create a two-fold barrier to specialty care. Uninsured children have more difficulty accessing primary care, which may be necessary for parents to even realize a need for specialty care. Even if they do receive primary care, the greater expense of specialty care may make it more difficult to access it, explain the researchers.

Many of the studies of access to specialty care for children insured by Medicaid or the State Children's Health Insurance Program suggest that children with public insurance have better access to specialty care than uninsured children. However, additional studies indicate that their access to specialists is worse and their specialists are less likely to be board-certified than privately insured children. For example, one study found that Medicaid-insured children with congenital heart disease were referred to pediatric cardiologists at older ages than children with managed care or other private insurance.

The findings of studies that investigated differences in specialty care access between children in managed care arrangements and those in other insurance arrangements were highly inconsistent. The study was supported in part by the Agency for Healthcare Research and Quality (HS13309 and T32 HS00032).

See "Effects of insurance status on children's access to specialty care: A systematic review of the literature," by Drs. Skinner and Mayer, in the BMC Health Services Research 7, 2007, which is available online at

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