Comparing Types of Health Insurance for Children: A Public Option versus a Private Option

BackgroundMany states have expanded public health insurance programs for children, and further expansions were proposed in recent national reform initiatives; yet the expansion of public insurance plans and the inclusion of a public option in state insurance exchange programs sparked controversies and raised new questions with regard to the quality and adequacy of various insurance types. ObjectivesWe aimed to examine the comparative effectiveness of public versus private coverage on parental-reported children's access to health care in low-income and middle-income families. Methods/Participants/MeasuresWe conducted secondary data analyses of the nationally representative Medical Expenditure Panel Survey, pooling years 2002 to 2006. We assessed univariate and multivariate associations between child's full-year insurance type and parental-reported unmet health care and preventive counseling needs among children in low-income (n=28,338) and middle-income families (n=13,160). ResultsAmong children in families earning <200% of the federal poverty level, those with public insurance were significantly less likely to have no usual source of care compared with privately insured children (adjusted relative risk, 0.79; 95% confidence interval, 0.63-0.99). This was the only significant difference in 50 logistic regression models comparing unmet health care and preventive counseling needs among low-income and middle-income children with public versus private coverage. ConclusionsThe striking similarities in reported rates of unmet needs among children with public versus private coverage in both low-income and middle-income groups suggest that a public children's insurance option may be equivalent to a private option in guaranteeing access to necessary health care services for all children.

[1]  P. Szilagyi,et al.  Does Public Insurance Provide Better Financial Protection Against Rising Health Care Costs for Families of Children With Special Health Care Needs? , 2008, Medical care.

[2]  Michael Seid,et al.  Enrolling Vulnerable, Uninsured but Eligible Children in Public Health Insurance: Association With Health Status and Primary Care Access , 2006, Pediatrics.

[3]  T. Selden,et al.  Access to Care and Utilization Among Children: Estimating the Effects of Public and Private Coverage , 2006, Medical care.

[4]  Elizabeth A McGlynn,et al.  The quality of ambulatory care delivered to children in the United States. , 2007, The New England journal of medicine.

[5]  L. DeRigne,et al.  The Influence of Health Insurance on Parent’s Reports of Children’s Unmet Mental Health Needs , 2009, Maternal and Child Health Journal.

[6]  S. Chu,et al.  Associations Between Childhood Vaccination Coverage, Insurance Type, and Breaks in Health Insurance Coverage , 2006, Pediatrics.

[7]  J. Steiner,et al.  Disruptions in Insurance Coverage: Patterns and Relationship to Health Care Access, Unmet Need, and Utilization Before Enrollment in the State Children's Health Insurance Program , 2007, Pediatrics.

[8]  J. Weiss,et al.  Insurance Status and Delay in Orthotic Treatment in Children , 2007, Journal of pediatric orthopedics.

[9]  P. Newacheck,et al.  Children in the United States with discontinuous health insurance coverage. , 2005, The New England journal of medicine.

[10]  D. Skaggs,et al.  Access to urologic care for children in California: Medicaid versus private insurance. , 2005, Urology.

[11]  G. Kenney,et al.  Effects of the State Children's Health Insurance Program Expansions on Children With Chronic Health Conditions , 2005, Pediatrics.

[12]  R. Kay,et al.  Access to Orthopaedic Care for Children With Medicaid Versus Private Insurance: Results of a National Survey , 2006, Journal of pediatric orthopedics.

[13]  G. Kenney,et al.  Preventive Care for Children in Low-Income Families: How Well Do Medicaid and State Children's Health Insurance Programs Do? , 2007, Pediatrics.

[14]  E. Shenkman,et al.  Health of children in title XXI: should we worry? , 2003, Pediatrics.

[15]  P. Newacheck,et al.  Children's access to primary care: differences by race, income, and insurance status. , 1996, Pediatrics.

[16]  B. Sommers.  Why millions of children eligible for Medicaid and SCHIP are uninsured: poor retention versus poor take-up. , 2007, Health affairs.

[17]  J. Eisenberg.  Agency for Health Care Policy and Research. , 1999, Medical care.

[18]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[19]  John L. Czajka,et al.  Dynamics in Medicaid and SCHIP eligibility among children in SCHIP's early years: implications for reauthorization. , 2007, Health affairs.

[20]  R. Andersen,et al.  A framework for the study of access to medical care. , 1974, Health services research.

[21]  S. Pati,et al.  Insurance Gaps Among Vulnerable Children in the United States, 1999–2001 , 2005, Pediatrics.

[22]  J. DeVoe,et al.  Children’s Receipt of Health Care Services and Family Health Insurance Patterns , 2009, The Annals of Family Medicine.

[23]  K. Wells,et al.  Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. , 2002, The American journal of psychiatry.

[24]  J. Sommers.  Some Relationships and Possible Models for State Estimates from the Medical Expenditure Panel Survey, Household Component , 2006 .

[25]  S. Blumberg,et al.  Unworried Parents of Well Children: A Look at Uninsured Children Who Reportedly Do Not Need Health Insurance , 2005, Pediatrics.

[26]  L. Ku,et al.  Public and private health insurance: stacking up the costs. , 2008, Health affairs.

[27]  J. DeVoe,et al.  Uninsured children and adolescents with insured parents. , 2008, JAMA.

[28]  Gordon Liu,et al.  Children's health insurance status and emergency department utilization in the United States. , 2003, Pediatrics.

[29]  S. Rosenbaum.  Medicaid and national health care reform. , 2009, The New England journal of medicine.

[30]  Sabrina T. Wong,et al.  Out-of-pocket financial burden for low-income families with children: socioeconomic disparities and effects of insurance. , 2005, Health services research.

[31]  The Effects of Varying Periods of Uninsurance on Children's Access to Health Care , 2009, Pediatrics.

[32]  J. Meara,et al.  Inequality of Access to Surgical Specialty Health Care: Why Children With Government-Funded Insurance Have Less Access Than Those With Private Insurance in Southern California , 2004, Pediatrics.

[33]  S. Zuvekas,et al.  Changes in access to care, 1977-1996: the role of health insurance. , 1999, Health services research.

[34]  P. Wise,et al.  Variability in pediatric utilization of trauma facilities in California: 1999 to 2005. , 2007, Annals of emergency medicine.

[35]  A. K. Taylor,et al.  The Medical Expenditure Panel Survey: a national health information resource. , 1996, Inquiry : a journal of medical care organization, provision and financing.

[36]  B. Starfield.  Access, primary care, and the medical home: rights of passage. , 2008, Medical care.

[37]  J. Swanson,et al.  Recommendations for Preventive Pediatric Health Care , 2000, Pediatrics.

[38]  E. Shenkman,et al.  Disenrollment and Re-enrollment Patterns in a SCHIP , 2002, Health care financing review.

[39]  C. Armon,et al.  Increased Rates of Morbidity, Mortality, and Charges for Hospitalized Children With Public or No Health Insurance as Compared With Children With Private Insurance in Colorado and the United States , 2006, Pediatrics.