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Child/Adolescent Health

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Uninsured children's access to care is influenced by the availability and capacity of a local safety net

Approximately 12 to 13 percent of U.S. children do not have health insurance, which means their access to care is influenced by the proximity of safety net providers (for example, community health centers, public housing primary care programs, and migrant health centers). In addition, the capacity of the safety net to serve the uninsured, as measured by local government funding for health and hospitals (such as outpatient health clinics, public hospitals, and immunization programs), plays a key role in determining access to care. Other characteristics of the local health care market, such as managed care penetration, play a part as well, according to a study supported by the Agency for Healthcare Research and Quality (HS10770).

Researchers studied a nationally representative group of more than 2,600 children aged 2 to 17 who were uninsured for at least 1 full calendar year from 1996 to 2000. Researchers found that 60 percent of uninsured children did not visit a physician's office during the year, and more than half had no care from a provider of any type (physician or non-physician) in an office-based setting. Nearly half of uninsured children had no medical expenditures or charges during the year. By comparison, other research has shown that nearly three-quarters of privately insured children and more than two-thirds of publicly insured children (such as those insured by Medicaid) had at least one physician visit, and more than 80 percent of privately and publicly insured children had some medical expenditures.

Researchers found differences between urban and rural uninsured children. For example, uninsured children in rural areas who lived closer to a safety net provider and lived in an area with a higher supply of primary care physicians (PCPs) were more likely to make physician visits and have more medical expenditures. Uninsured children in urban areas with a greater local supply of PCPs and higher level of safety net funding from the local government were more likely to have higher medical expenditures. While proximity to safety net providers was not found to be a determinant of access to care among uninsured urban children, researchers caution that other factors influencing the accessibility of providers (such as availability of local public transit) were not measured and may influence the services urban uninsured children receive. The study further found that the greater the percentage of the urban population that was uninsured, the less likely the use of the emergency department (ED) by uninsured children. Thus, ED crowding may be a severe problem in urban areas with many uninsured.

These findings were based on analysis of 1996 to 2000 data from the nationally representative Medical Expenditure Panel Survey, which was linked to other national data sources on hospital and market characteristics.

See "Dimensions of the local health care environment and use of care by uninsured children in rural and urban areas," by Carole Roan Gresenz, Ph.D., Jeannette Rogowski, Ph.D., and José J. Escarce, M.D., Ph.D., in the March 2006 Pediatrics 117, pp. 509-517.

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