Abstract
Objective
To examine trends in children's health access, utilization, and expenditures over
time (2002–2009) by race/ethnicity, income, and insurance status/expected payer.
Methods
Data include a nationally representative random sample of children in the United States
in 2002–2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample
of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization
Project (HCUP).
Results
The percentage of children with private insurance coverage declined from 65.3% in
2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children
increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured
in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic
children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3%
in 2009. The uninsured were consistently the least likely to have access to a usual
source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites
were most likely to report a usual source of care in both 2002 and 2009. The percentage
of children with a doctor visit improved for whites and Hispanics (2009 vs 2002).
In contrast, black children saw no improvement during this time period. Between 2002
and 2009, children's average total health care expenditures increased from $1294 to
$1914. Average total expenditures nearly doubled between 2002 and 2009 for white children
with private health insurance. Among infants, hospitalizations for pneumonia decreased
in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%).
Fluid and electrolyte disorders also decreased over time. Influenza appeared only
in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children
aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to
134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top
15 categories in 2009, with 57,000 cases (3.3% of total).
Conclusions
Despite significant improvement in insurance coverage, disparities by race/ethnicity
and income persist in access to and use of care. Hispanic children experienced progress
in a number of measures, while black children did not. Because racial/ethnic and socioeconomic
disparities are often reported as single cross-sectional studies, our approach is
innovative and improves on prior studies by examining population trends during the
time period 2002–2009. Our study sheds light on children's disparities during the
most recent economic crisis.
Keywords
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Article info
Publication history
Accepted:
February 5,
2013
Received:
August 30,
2012
Footnotes
The views expressed in this article are those of the authors and do not necessarily represent those of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
Identification
Copyright
© 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
