Adolescent Health Insurance Coverage: Recent Changes and Access to Care

Newacheck, Paul W.; Brindis, Claire; Cart, Courtney Uhler; Marchi, Kristen; Irwin, Charles E.; Jr, MD

doi:10.1542/peds.104.2.195

Cited by 138 publications

(76 citation statements)

References 12 publications

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“…Previous research has established that individuals without health insurance have poor access to medical care across a number of important indicators, including having a usual source of medical care, having at least one physician visit during a given year, and having confi dence that they can obtain care when needed (Haley and Zuckerman 2000;Hoffman et al 2001;Kasper, Giovannini, and Hoffman 2000;Nelson et al 1999;Newacheck et al 1998;Newacheck et al 1999;Shi 2000;Zuvekas and Weinick 1999). Individuals without health insurance are also more likely to forgo preventive and routine care for chronic conditions (Ayanian et al 2000).…”

Section: The Consequences Of Being Uninsuredmentioning

confidence: 99%

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

2010

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Millions of people in the United 2002a;Osteen et al. 1994;Roetzheim et al. 1999). Being uninsured also poses serious fi nancial threats to Americans, with millions carrying a large burden of debt from medical expenses ( Himmelstein et al. 2005). Although public programs-such as Medicaid and the State Children's Health Insurance Program (SCHIP)-provide health insurance to many who would otherwise not be able to afford coverage, millions are without health insurance.In this article, we argue that current research offers a limited description of health insurance coverage in the United States, especially with respect to racial disparities. More specifi cally, the literature to date does not give a sense of the duration of exposure to being uninsured over a typical lifetime, nor does it address the joint risk of being uninsured and being unhealthy. Yet, having an estimate of the duration of time that individuals typically live with these risks is essential in assessing the magnitude of the insurance-related challenges facing the United States. Moreover, having durational measures of the joint risk of being uninsured and in different health states is particularly important when examining disparities between whites and blacks because blacks are not only more likely to be uninsured but also more likely to experience adverse health events. In this study, we use a life table approach to examine racial differences in health insurance coverage in the United States by calculating health-and insurance-specifi c life expectancies for whites and blacks. These measures capture the duration of exposure to different insurance and health states during a typical lifetime. In the absence of individual data on lifetime insurance coverage, life table analysis is a valuable tool that enables us to simulate life course experiences with health insurance coverage and health. By creating measures with a focus on the lifetime exposure to the joint risks of being uninsured and less healthy, we hope not only to provide a better understanding of issues related to health insurance coverage in the United States but also to elucidate racial disparities in the current U.S. health care system. Specifi cally, we address three important questions. First, how does the proportion of time spent in different health and insurance states over the course of one year differ by age and race? Second, given current age-specifi c mortality, subjective health, and health insurance rates in the United States, how many years can individuals expect to live with different types of insurance coverage and in different health states over a typical lifetime? Third, how large are the differences between blacks and whites in the expected number of years lived in different health-specifi c insurance states? BACKGROUND

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Section: The Consequences Of Being Uninsuredmentioning

confidence: 99%

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

2010

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“…Age was grouped on the basis of the categories used in the AAP's recommendations for preventive care: early childhood (ages 3-4), middle childhood (ages 5-10), early adolescence (ages [11][12][13][14], and late adolescence (ages [15][16][17]. Data were not collected with enough detail to determine receipt of well-child and dental care among children younger than 3 years.…”

Section: Description Of Variablesmentioning

confidence: 99%

“…11 Older adolescents (15-18 years) were more likely to be uninsured than younger adolescents (10 -14 years). 12 Before enrollment in a State Children's Health Insurance Program (SCHIP), older uninsured children experienced more unmet needs, delayed care, and parental limits on activities as well as fewer health care visits and a longer period of being uninsured than younger uninsured children. 13 Receipt of care based on the American Academy of Pediatrics' (AAP's) Recommendations for Preventive Pediatric Health Care is important because these guidelines present the consensus opinion of pediatric experts for the appropriate number and timing of preventive care visits.…”

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confidence: 99%

Factors That Influence Receipt of Recommended Preventive Pediatric Health and Dental Care

Yu¹,

Bellamy²,

Kogan³

et al. 2002

Pediatrics

130

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ABSTRACT.Objective. This study examined the factors that affect children's receipt of recommended wellchild and dental visits using nationally representative data.Methods. We analyzed the Child Public Use File of the 1999 National Survey of America's Families, including 35 938 children who were younger than 18 years. Bivariate and multivariate analyses were conducted to examine the relationship between dependent variables, including receipt of well-child visits as recommended by the American Academy of Pediatrics' periodicity schedule and dental visits as recommended by the American Academy of Pediatric Dentistry and Bright Futures, and independent variables, including health status and sociodemographic and economic indicators.Results. Overall, 23.4% of children did not receive the recommended well-child visits, whereas 46.8% did not receive the recommended number of dental visits. The factors that predict nonreceipt of care differed for wellchild and dental care and with child's age. Logistic regression reveals that children who were young (<10 years old), uninsured, non-Hispanic white, had a parent who was less than college educated, or in poor health were least likely to meet the recommendations for wellchild care. Children who did not meet the dental recommendation were more likely to be black, uninsured, from families with low incomes, have a parent who was less than college educated, and have postponed dental care in the last year. These risk factors increased with children's age.Conclusions. A substantial proportion of US children do not receive preventive care according to professionally recommended standards, particularly dental care. Publicly insured children experience higher rates of recommended well-child visits; however, much improvement is needed among public programs in providing recommended dental care, especially among adolescents and children in poor general health. Pediatrics 2002;110(6). URL: http://www.pediatrics.org/cgi/content/ full/110/6/e73; child, dental health services, multivariate analysis, preventive health services, professional organizations.

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“…Remaining unadjusted differences were calculated in the same manner and then compared with the adjusted differences (shown only in this reduces preexisting disparities. National-level analyses suggest that health disparities have not been reduced in children over the past 2 decades, despite expansion of Medicaid and other efforts to provide health insurance to children, 40,[89][90][91] and that racial/ ethnic disparities persist even within populations that have similar insurance coverage. 35,92 Two of our findings demonstrate important successes of SCHIP in addressing racial/ethnic disparities.…”

mentioning

confidence: 99%

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Shone¹,

et al. 2005

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ABSTRACT. Background. Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll.Objectives. The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors.Methods. Pre/post-parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP.Results. Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured >12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/ most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period.Conclusions. Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care. R acial/ethnic disparities in health care delivery are associated with adverse hea...

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Adolescent Health Insurance Coverage: Recent Changes and Access to Care

Cited by 138 publications

References 12 publications

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

Factors That Influence Receipt of Recommended Preventive Pediatric Health and Dental Care

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

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