Factors Associated with Parent Report of Access to Care and the Quality of Care Received by Children 4 to 17 Years of Age in Georgia

Abstract

We examined factors associated with health care access and quality, among children in Georgia. Data from the 2007 National Survey of Children's Health were merged with the 2008 Area Resource File. The medically underserved area variable was appended to the merged file, restricting to Georgia children ages 4-17 years (N = 1,397). Study outcomes were past-year access to care, defined as utilization of preventive medical care and no occasion of delay or denial of needed care; and quality of care received, defined as compassionate, culturally-effective, and family-centered care which was categorized as higher, moderate, or lower. Analysis included binary and multinomial logit modeling. In our study population, 80.8 % were reported to have access to care. The quality of care distribution was: higher (39.4 %), moderate (30.6 %), and lower (30.0 %). Younger age (4-9 years) was positively associated with having access to care. Compared to children who had continuous and adequate private insurance, children who were never/intermittently insured or who had continuous and inadequate private insurance were less likely to have access. Compared to children who had continuous and adequate private insurance, there were lower odds of perceiving received care as higher/moderate versus lower quality among children who were never/intermittently insured or who had continuous and inadequate/adequate public insurance. Being in excellent/very good health and living in safe/supportive neighborhoods were positively associated with quality; non-white race/ethnicity and federal poverty level were negatively associated with quality. Assuring continuous, adequate insurance may positively impact health care access and quality.

Timely Access to Quality Health Care Among Georgia Children Ages 4 to 17 Years

“…Separate models were developed for each domain of Andersen's theoretical framework as a step to building the final overall model. A conservative cut-off, p = 0.3 in bivariate analysis from our previous work [27] was used as the criterion for entry into the domain specific models and then within the current study for entry into the full model. For modeling, the access to higher quality care and access to moderate quality care groups were combined during preliminary work that demonstrated similar effect sizes between these two groups.…”

“…Each of these constructs were examined independently in previously published work, providing the evidence necessary for supporting the development of a composite variable that merges the two constructs. Access to care and quality of care were defined consistent with this previously published work [27]. Access to health care is a dichotomous outcome derived from two survey items: utilization of any preventive medical care, and delay or non-receipt of needed care; both in the prior 12 months.…”

“…Variables in this domain include the number of federally qualified health centers (FQHCs), MUAs, health professional shortage areas for primary care in the county, rural-urban designation at the county level, insurance coverage (never/intermittently insured, continuous-inadequateprivate, continuous-inadequate-public, continuous-adequate-private, continuous-adequatepublic), income status (measured as the percentage of the 2007 federal poverty level [FPL]), having a usual source of care (USC), and having a personal health care provider. The insurance coverage variable is a composite variable created from questions covering current insurance; gaps in the previous 12 months; adequacy in terms of benefits, providers, and out-of-pocket costs; and insurance type (public or private) [27]. The need domain includes child's special health care need status and child's overall health status.…”

A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

“…With the use of these EHR-based tools, patients are likelier to stay insured. Continuous health insurance is associated with timely access to health care services [26–29], which leads to fewer unmet health care needs, a lower likelihood of delayed receipt of preventive care services [30–32], and reductions in preventable mortality [4, 5]. …”

Introduction to the Special Issue of Articles from the 2007 National Survey of Children’s Health

“…In response to the Georgia Title V Needs Assessment completed in 2010, Ogbuanu and colleagues [11] investigated factors associated with access to and quality of care for Georgian children by merging data from the 2007 NSCH with county-level data from the Area Resource File. While the majority of Georgian children were found to have access to health care, reported quality differed by continuity and adequacy of insurance coverage suggesting the need to identify new and innovative methods of extending and retaining comprehensive coverage for children in Georgia.…”