Objectives.—To examine differences by income in insurance coverage, health care utilization,
expenditures, and quality of care for children in the United States.
Methods.—Two national health care databases serve as the sources of data for this report:
the 2000–2002 Medical Expenditure Panel Survey (MEPS) and the 2001 Nationwide Inpatient
Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). In the MEPS
analyses, low income is defined as less than 200% of the federal poverty level and
higher income is defined as 200% of the federal poverty level or more. For the HCUP
analyses, median household income for the patient's zip code of residence is used
to assign community-level income to individual hospitalizations.
Results.—Coverage. Children from low-income families were more likely than children from middle–high-income
families to be uninsured (13.0% vs 5.8%) or covered by public insurance (50.8% vs
7.3%), and less likely to be privately insured (36.2% vs 87.0%). Utilization. Children from low-income families were less likely to have had a medical office
visit or a dental visit than children from middle–high-income families (63.7% vs 76.5%
for office-based visits and 28.8% vs 51.4% for dental visits) and less likely to have
medicines prescribed (45.1% vs 56.4%) or have utilized hospital outpatient services
(5.2% vs 7.0%), but more likely to have made trips to the emergency department (14.6%
vs 11.4%). Although low-income children comprise almost 40% of the child population,
one quarter of total medical expenditures were for these children. Hospital Discharges. Significant differences by community-level income occurred in specific characteristics
of hospitalizations, including admissions through the emergency department, expected
payer, mean total charges per day, and reasons for hospital admission. Leading reasons
for admission varied by income within and across age groups. Quality. Low-income children were more likely than middle–high-income children to have their
parents report a big problem getting necessary care (2.4% vs 1.0%) and getting a referral
to a specialist (11.5% vs 5.3%). Low-income children were at least twice as likely
as middle–high-income children to have their parents report that health providers
never/sometimes listened carefully to them (10.0% vs 5.1%), explained things clearly
to the parents (9.6% vs 3.4%), and showed respect for what the parents had to say
(9.2% vs 4.2%). Children from families with lower community-level incomes were more
likely to experience ambulatory-sensitive hospitalizations. Racial/Ethnic Differences Between Income Groups. Use and expenditure patterns for most services were not significantly different between
low- and middle–high-income black children and were lower than those for white children.
Conclusions.—While health insurance coverage is still an important factor in obtaining health
care, the data suggest that efforts beyond coverage may be needed to improve access
and quality for low-income children overall and for children who are racial and ethnic
minorities, regardless of income.
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Article Info
Publication History
Accepted:
November 2,
2004
Received:
July 16,
2004
Footnotes
The views expressed in this article are those of the authors and do not necessarily represent those of the AHRQ or the US Department of Health and Human Services
Identification
Copyright
© 2005 Ambulatory Pediatric Association. Published by Elsevier Inc. All rights reserved.
