Elsevier

Academic Pediatrics

Volume 11, Issue 4, July–August 2011, Pages 305-310
Academic Pediatrics

Issues in Health Care Delivery
Medical Home Disparities Between Children With Public and Private Insurance

https://doi.org/10.1016/j.acap.2011.03.006Get rights and content

Abstract

Objective

To compare the prevalence of a medical home for children with public versus private insurance and identify components of the medical home that contribute to any differences.

Methods

We performed a secondary data analysis of the 2007 National Survey of Children's Health. A medical home was defined as meeting each of 5 components: 1) usual source of care; 2) personal doctor/nurse; 3) family-centered care; 4) care coordination, if needed; and 5) no problems getting a referral, if needed. We estimated the national prevalence of the medical home and its components for children with public versus private insurance. Comparisons were made using logistic regression, unadjusted and adjusted for sociodemographic factors.

Results

A total of 67% of privately insured children met all 5 components of the medical home, compared with only 45% of publicly insured children (P < .001). The gap in medical home prevalence between public and private groups remained significant after controlling for sociodemographic characteristics (public vs private adjusted odds ratio [AOR] 0.82; 95% confidence interval [95% CI] 0.73–0.92). Over 90% of children in both groups reported having a usual source of care and a personal doctor/nurse. Only 58% of publicly insured children reported family-centered care, compared with 76% of privately insured children (P < .001). This difference was significant after adjustment for sociodemographic characteristics (public vs private AOR 0.87; 95% CI 0.77–0.99).

Conclusions

Significant medical home disparities exist between publicly and privately insured children, driven primarily by disparities in family-centered care. Efforts to promote the medical home must recognize and address determinants of family-centered care.

Section snippets

Methods

For this analysis, we used publicly available data from the 2007 National Survey of Children's Health (NSCH). The NSCH is a nationally representative telephone survey of households with children ages 0–17 years, stratified by state to allow for national and state estimates of a wide variety of child health indicators. The survey is sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration. The 2007 NSCH had a final sample size of 91 642 children

Sample Demographics

In this nationally representative sample (unweighted n = 91 642), 29% of children had public insurance and 62% had private insurance. Compared with privately insured children, the publicly insured group was younger on average and included more children who were from a racial/ethnic minority, had a special health care need, spoke a primary language other than English, and had a mother with low education (Table 2).

National Estimates of the Medical Home Composite by Insurance Type

In the United States, only 45% of children with public insurance met all 5

Discussion

Significantly fewer publicly insured than privately insured children report a medical home, using a broadly adopted composite measure of medical home in this recent, nationally representative sample. Our examination of the individual components of the medical home measure illustrates that this insurance-based disparity has less to do with basic access to primary care (usual source of care or personal doctor/nurse) than with disparities in perceptions of physician-family interactions

Acknowledgment

J.S.Z. was supported by a training grant from the National Institute of Child Health and Human Development (T32 HD07534).

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    The authors have no conflicts of interest to disclose.

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