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Medicaid-, CHIP-insured children utilize more preventive care than privately insured children
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Recent research in JAMA Pediatrics found that preventive medical and dental care visits were more prevalent among children insured by Medicaid and the Children’s Health Insurance Program compared with privately insured children.
“This study examined the experiences with health insurance coverage for families with incomes between 100% and 300% of the federal poverty level and found consistently high levels of preventive care receipt for all insured children,” David M. Rubin, MD, MSCE, associate professor of the department of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “However, preventive medical and dental visits were more prevalent for children insured by Medicaid and CHIP than for privately insured children.”
David M. Rubin
The researchers analyzed data from the National Surveys of Children’s Health from 2003, 2007 and 2011-2012. Survey data included information from 80,655 children aged 17 and younger, with household incomes ranging from 100% to 300% of the federal poverty level. Insurance type also was gathered via caregiver-reported responses to survey questions.
Findings revealed 57.3% of children had private insurance, 18.4% had CHIP, 13.6% had Medicaid, and 10.8% had no coverage.
Children insured with Medicaid or CHIP were more likely to report access to preventive primary care (88% for either plan) and dental care (80% and 77%, respectively; P < .01) when compared with privately insured children (medical, 83%; dental, 73%; P < .01). However, approximately 25% of caregivers for children across all insurance types reported difficulty accessing specialty care. Children with CHIP were most likely to experience difficulty gaining specialty care, difficulty obtaining a referral and frustration obtaining health care services.
Rubin and colleagues also wrote that parents of privately insured children were more likely to face out-of-pocket expenses vs. children covered by Medicaid and CHIP (P < .01).
“Under the Affordable Care Act, qualified health plans are expanding the availability of private insurance for families with low incomes, but the early experiences with qualified health plans have been mixed,” the researchers said. “Ongoing evaluation is needed to ensure that policy decisions are responsive to [reported] differences so that historical strides made in pediatric health coverage do not recede.”
In a related editorial, David M. Keller, MD, of the department of pediatrics at the University of Colorado School of Medicine, applauded Rubin and colleagues, describing their study results as “good science … that generates the next set of questions that must be addressed.” Keller also elaborated on the further areas of study needed to fully understand what factors lead to pediatric health care access disparities between coverage types.
“Why are families having such difficulty in accessing services for their children,” Keller wrote. “Is it the out-of-pocket expenses? If so, the Affordable Care Act and the health insurance exchange plans are likely to make that worse since consumers seem to be favoring the less expensive, high-deductible plans when offered a choice.
“We must figure out how to ensure that all families, whatever their insurance status, have access to the care that their children need.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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