Issues in Health Care DeliveryMedical Home Disparities Between Children With Public and Private Insurance
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).
References (43)
- et al.
Association of medical home care and disparities in emergency care utilization among children with special health care needs
Acad Pediatr
(2009) - et al.
Racial and ethnic disparities in indicators of a primary care medical home for children
Acad Pediatr
(2009) The convergence of vulnerable characteristics and health insurance in the US
Soc Sci Med
(2001)- et al.
Primary care quality and subsequent emergency department utilization for children in Wisconsin Medicaid
Acad Pediatr
(2009) - et al.
Disparities in the national prevalence of a quality medical home for children with asthma
Acad Pediatr
(2009) American Academy of Pediatrics. The medical home
Pediatrics
(2002)- Patient-Centered Primary Care Collaborative. 2010. Available at: http://www.pcpcc.net/. Accessed June 3,...
- et al.
A nationwide survey of patient centered medical home demonstration projects
J Gen Intern Med
(2010) - Kaye N, Takach M. Building Medical Homes in State Medicaid and CHIP Programs. National Academy for State Health Policy;...
- et al.
Improved outcomes associated with medical home implementation in pediatric primary care
Pediatrics
(2009)
A review of the evidence for the medical home for children with special health care needs
Pediatrics
Does access to a medical home differ according to child and family characteristics, including special-health-care-needs status, among children in Alabama?
Pediatrics
History of the medical home concept
Pediatrics
Access to the medical home: results of the National Survey of Children With Special Health Care Needs
Pediatrics
Access to the medical home: new findings from the 2005–2006 National Survey of Children With Special Health Care Needs
Pediatrics
Medicaid, underinsurance, and the dawn of an era for children's coverage
Pediatrics
Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients
Pediatrics
Factors associated with pediatricans participation in Medicaid in North Carolina
JAMA
Medicaid participation by private and safety net pediatricians, 1993 and 2000
Pediatrics
Quality of primary care and subsequent pediatric emergency department utilization
Pediatrics
Cited by (25)
Nationwide analysis of mortality and hospital readmissions in esophageal atresia
2020, Journal of Pediatric SurgeryCitation Excerpt :The NRD unfortunately lacks variables on race/ethnicity; however, many studies have shown that race does in fact have an effect on readmission rates [19–21]. This socioeconomic impact is thought to be partially owing to a lack of reliable outpatient care or medical homes to aid in the needs of medically-complex children [22,23]. Previously unreported, our analysis demonstrates that certain congenital and perinatal factors significantly impacted readmission rates.
Primary Care and Home Visiting Utilization Patterns among At-Risk Infants
2018, Journal of PediatricsSocioeconomic and Racial Disparities in Parental Perception and Experience of Having a Medical Home, 2007 to 2011–2012
2017, Academic PediatricsCitation Excerpt :Some advocates have proposed that the medical home—by delivering high-quality primary care and improving child health—could be a promising model to reduce SES disparities in health. A previous study found that disparities in medical home access for publicly versus privately insured children were driven primarily by differences in family-centered care.28 Underserved children often receive care in pediatric practices where resources are limited and with high patient volume making it harder for pediatric providers to deliver quality family-centered care.20
The authors have no conflicts of interest to disclose.