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 Steep declines in the number of uninsured have been well documented,
largely as a result of growth in Medicaid and the Children’s Health
Insurance Program. But the current study offers fresh evidence that
kids are not only getting insured – they’re also becoming more
likely to receive the care they need.
“In addition to having improved insurance coverage we showed that
children’s utilization patterns improved, meaning that fewer
children lacked well child visits, or had unmet health needs as
their gains in coverage improved,” said study co-author Dr. Andrew
Racine, a pediatrics researcher and chief medical officer for
Montefiore Health System in New York City.
With growth in coverage, some racial and economic disparities in
kids’ use of health services got smaller, Racine said by email.
“It turns out that the most vulnerable children – i.e. racial and
ethnic minorities and those coming from families with fewer
resources – recorded proportionally greater gains over time,” Racine
added.
To assess shifts in children’s insurance and access to care,
researchers analyzed U.S. survey data collected on about 178,000
children under age 18 from 2000 to 2014.
Among all children, uninsured rates declined from 12.1 percent in
2000 to 5.3 percent in 2014, researchers report in Pediatrics.
For Hispanic kids in particular, the proportion lacking a usual
source of healthcare dropped from 13.9 percent at the start of the
study to 6.3 percent bythe end. The proportion of Hispanic children
who had no doctor visits fell from 19.8 percent to 11.9 percent,
while the proportion missing dental exams declined from 43.2 percent
to 21.8 percent.
Black children also saw significant, if slightly less dramatic,
gains. The proportion of black kids lacking a usual source of care
fell from 8.4 percent to 3.6 percent during the study period. At the
same time, the proportion that had no doctor visits dropped from
14.4 percent to 8.8 percent.
Even though white children also experienced improvements in access
to care, gains for them were not as pronounced as for black and
Hispanic kids.
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One limitation of the study is its reliance on parents to accurately
recall and report on the children’s insurance status and the care
they received, the authors note. It’s also possible that parents who
participated in the study might have kids with better access to care
than parents who declined to respond to the surveys, the researchers
point out.
Even so, the findings highlight the importance of the Children’s
Health Insurance Plan (CHIP) in providing safety-net coverage to
kids, Dr. Stephen Berman, of the University of Colorado School of
Medicine, writes in an accompanying editorial.
CHIP, set to expire in 2019, offers low-cost coverage for children
from low-income families, many of whom might not qualify for premium
subsidies under the Affordable Care Act, Berman writes.
“With passage and implementation of the Children's Health Insurance
Program we saw a steady decline in the number of uninsured children,
however there were still many children eligible for public programs
that were not enrolled,” Berman told Reuters Health by email.
“Passage of the Affordable Care Act encouraged the enrollment of
these children,” Berman said. “This may have been the result of
making the parents eligible for Medicaid and providing subsidies to
help low income families purchase insurance.”
SOURCE: http://bit.ly/2eGUCBW Pediatrics, online November 15, 2016.
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