Insured Kids With Uninsured Parents Miss Needed Health Care

THURSDAY Sept. 17, 2009 -- Children with health insurance coverage are more likely to miss necessary health-care services if their parents are uninsured, new research shows.

These children are at greater risk of having difficulty seeing a doctor, getting dental care and accessing prescription medications than kids in families where children and parents are insured. They're also less likely to receive counseling on healthy eating, routine exercise, use of a safety or booster seat, and use of seatbelts and bike helmets, the study found.

The findings highlight the need to improve the current model of extending health insurance to children, but not necessarily to their parents, the study authors said.

"We've been incrementally covering more and more kids, and that's important, but we can't stop there," said study lead author Dr. Jennifer E. DeVoe, an assistant professor in the Department of Family Medicine at Oregon Health and Science University in Portland. "We need to make sure that families are covered -- kids and parents."

More than one in four children in the United States -- 29 percent -- have health coverage through either Medicaid or the Children's Health Insurance Program (CHIP), according to the Henry J. Kaiser Family Foundation. Currently, some 29 million children are enrolled in Medicaid, and another 7 million are covered through CHIP, the foundation said.

While these public programs are considered vital for improving children's health, they are only part of the solution, experts say.

"In the public-policy arena, there is often a tendency to consider children a 'deserving' population who should have greater access than adults to publicly sponsored health insurance," said Shana Alex Lavarreda, a research scientist for the Center for Health Policy Research at the University of California, Los Angeles, and director of health insurance studies. CHIP is a prime example, she explained.

"But if you really care about improving access to health care for children, their parents' needs for health insurance coverage shouldn't be ignored," Lavarreda said.

For the study, DeVoe and her colleagues pooled five years of data from a national survey of U.S. households. The sample included more than 43,000 children ages 2 to 17.

To assess children's access to health care, the researchers looked at a number of variables, including gaps in coverage over the previous 12 months, no usual source of care, no doctor visits in the past year, fewer than yearly dental visits, and other problems accessing health care and preventive counseling services.

Not surprisingly, uninsured children had the highest rates of unmet health-care needs. But the study also showed an association between parents' insurance status and children's access to health care.

"Parents who are themselves uninsured may have other constraints on whether they can get health care for their children," Lavarreda noted. They may not be able to take time from work to take their children to the doctor, for example, she said.

"Additionally, parents who are uninsured may have difficulties navigating the health-care system and may be unfamiliar with how to obtain services," Lavarreda said.

The authors found no significant difference in preventive counseling services by race or ethnicity. Hispanic children were actually less likely to miss out on preventive counseling compared with non-Hispanic whites. DeVoe said she suspects that these families are accessing care through community health centers, where nurses, nursing assistants and other non-physician clinicians are spending time counseling families.

Even in families where the parents and children are insured, significant percentages lack preventive counseling, which suggests that the problem isn't just one of insurance status. The model of care can also make a difference, the researchers said.

"The way that care is set up in the majority of clinics across the country is the child checks in for their visits, sees a physician for a very short period of time and, increasingly, there's more and more counseling and medical information that's required to be communicated to the family," DeVoe said.

The study findings were published in the September/October issue of Annals of Family Medicine.

More information

Learn more about children's health insurance coverage at the Kaiser Family Foundation.

Posted: September 2009


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