Section 2—Children's Access to Health Care

Having adequate access to health care services can significantly influence health care use and health outcomes. Consequently, measures of access to care are an important tool for evaluating the quality of the Nation's health care system. Limitations in access to care extend beyond such simple issues as a shortage of health care providers or facilities in some areas. Even where health care services are readily available, people may not have a usual source of health care or may experience barriers to receiving services because of financial or insurance restrictions, a lack of availability of providers at night or on weekends, or other difficulties.

One extensively studied indicator of access is having a usual source of care.

Do children have a place to go when they are sick or need health care?

Persons with a usual source of health care have been shown to be more likely to receive a variety of preventive health services than those without a usual source of care. However, all usual sources of care are not the same. Office-based sources may cost less and provide better continuity of care.

• Children aged 13-17 were less likely than younger children to have a usual source of health care.
• Children aged 13-17 were also less likely to have an office-based usual source of health care.

Select to access Figure 7 (5 KB).

Are minority children at greater risk of not having a usual source of care?

Hispanic and black children were less likely than white children to have a usual source of care and less likely to have an office-based usual source of care.

• Hispanic children were less likely than children in any other racial/ethnic group to have a usual source of health care.
• Black children were less likely than white children to have a usual source of health care.
• Hispanic and black children were less likely than white children to have an office-based usual source of care, and were more likely to have a hospital-based usual source of care. 

Select to access Figure 8 (5 KB).

Does health insurance affect children's chances of having a usual source of care?

Children with private health insurance were more likely to have a usual source of care than those who had public insurance or were uninsured.

• 20.2% of uninsured children lacked a usual source of health care.
• Children who were uninsured were 3.6 times more likely to lack a usual source of care when compared to children with private insurance.
• Children who were uninsured were twice as likely as those with public insurance to lack a usual source of care. 

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Do children with a usual source of care get the care they need when they need it?

Characteristics of usual sources of health care that can affect access to care include having office hours at times when parents are not working and being easy to contact by phone. Among children under age 18 who had a usual source of care:

• 40.6% had a provider who did not have night and weekend office hours.
• 22.1% of these children's families found their usual source of care providers "somewhat" or "very" difficult to contact by telephone.

How satisfied are families with their usual source of care?

Satisfaction and continuity of care are important aspects of high-quality health care. Families of children with a usual source of care reported that:

• 97.5% were "somewhat" or "very" satisfied with their usual source of care.
• 96.9% had a usual source of care provider who generally listened and gave them needed information about health and health care.
• 74.9% had a usual source of care provider who generally asked questions about prescription medicines and treatments from other doctors.

Why don't some children have a usual source of care?

While more than 91% of children under age 18 had a usual source of care, 8.8% had no usual source of health care. Of these:

• 65.9% had no usual source of care because they seldom or never got sick.
• 7.8% had no usual source of care because they recently moved to the area or did not know where to receive care.
• 10.0% had no usual source of care because their families could not afford medical care. 

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Why don't some families get health care when they need it?

Approximately 12.8 million families (11.6% of all American families) experienced difficulty or delay in obtaining care, or did not receive needed health care services. (See Note 3.)

• Among these families, inability to afford health care was cited by the majority (59.9%) as the main problem. Another 19.5% cited insurance-related reasons as the main obstacle to receiving care. (See Note 4.)
• Families with a Hispanic head of household, or with one or more uninsured members, were substantially more likely to report experiencing barriers to receiving needed health care.

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Note 3. The statistics about "Why don't some families get health care when they need it?" are not limited to families with children.

Note 4. Insurance-related reasons include "insurance company wouldn't approve, cover, or pay for care," "pre-existing condition," "insurance required a referral but couldn't get one," and "doctor refused to accept family's insurance plan."

Section 3—Children's Health Status

One main objective of our health care system is to maintain and improve American children's health. Consequently, children's health outcomes provide one indication of how well the system is functioning.

Answers to simple questions like the one reported here (which asked "Would you rate this child's health as excellent, very good, good, fair or poor?") have been shown to predict both demand for medical care services and medical outcomes.

Children's health status: Where do we stand?

• 80.2% of all children under the age of 18 were in excellent or very good health.
• Less than 1% of children were in poor health.
• Although they represent just under 4% of all American children under the age of 18, 2.8 million children were in fair or poor health.

Select to access Figure 12 (3 KB).

Are minority children at greater risk of poor health?

Children's health status varies by racial and ethnic group. This may in part be explained by differences in access to adequate health care.

• Hispanic children were more likely than black or white children to be in fair or poor health (7.8% of Hispanic children, compared with 4.2% of black children and 2.9% of white children).
• Black and Hispanic children were less likely than white children to be in excellent health (48.1% of black children and 42.9% of Hispanic children, compared with 55.1% of white children).

Select to access Figure 13 (5 KB).

Where do children in fair or poor health get their health insurance?

Children in fair or poor health were far more likely than children in excellent health to have public insurance. Children in excellent health were more likely to have private insurance. Because of public health care coverage, children with health problems were as likely to be insured as children in excellent health.

• Of children in fair or poor health, only 42.8% had private health insurance and 41.8% had public health insurance. Of children in fair or poor health, 15.4% had no insurance coverage.
• Of children in excellent health, 70.1% had private health insurance coverage, while 15.1% had public health insurance and 14.8% were uninsured.

Select to access Figure 14 (5 KB).

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Conclusions

The data presented in this report suggest that:

• In spite of various policy initiatives, a substantial number of children in America remain uninsured.
• Black and Hispanic children are at increased risk of adverse outcomes, including being uninsured and being in poor health.
• Having a working parent is not enough to ensure children's access to private health insurance.
• The most common reason children do not get needed health care is because their families cannot afford it.
• Public coverage is a critical factor in providing insurance for children with health problems.

Looking Ahead—Future MEPS Data on Children

This report presents estimates of children's health insurance coverage, access to health care, and health status. Future data from MEPS will address a number of additional aspects of children's health care, including:

• The impact of managed care.
• Use of specific services.
• Use of preventive health services, including immunization status.
• Amounts paid for health care and sources of payment.
• Additional measures of health status, including health conditions and functional limitations.
• Changes in children's health insurance status over time.
• Amounts families pay for private health insurance coverage.

MEPS is a unique data resource for monitoring our Nation's health care system. As an ongoing survey, MEPS will produce data that can be used to examine changes over time.

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References

Agency for Health Care Policy and Research. Medical Expenditure Panel Survey Insurance Status Tables: First Half of 1996. Rockville (MD); 1997, AHCPR Pub. No. 97-R052.

Banthin JS, Cohen JW. Changes in the Medicaid community population, 1987-1996. Paper presented at the 1997 Annual Meeting of the Association for Health Services Research.

Monheit AC, Vistnes JP. Health insurance status of workers and their families: 1996. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 2. AHCPR Pub. No. 97-0065.

Vistnes JP, Monheit AC. Health insurance status of the civilian noninstitutionalized population: 1996. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 1. AHCPR Pub. No. 97-0030.

Weinick RM, Zuvekas SH, Drilea SK. Access to health care—sources and barriers, 1996. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 3. AHCPR Pub. No. 98-0001.

Weinick RM, Monheit AC. Family structure and children's health insurance coverage, 1977-1996. Paper presented at the 1997 Annual Meeting of the Association for Health Services Research.

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Current as of March 1998
AHCPR Publication No. 98-0008

Internet Citation:

Children's Health, 1996. MEPS Chartbook No. 1. Weigers ME, Weinick RM, Cohen JW. Agency for Health Care Policy and Research, Rockville MD. AHCPR Publication No. 98-0008, March 1998. http://www.ahrq.gov/research/chrtbk1/chrtbk1a.htm

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