Access To Health Care Part 1: Children

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Series 10No. 196Vital andHealth StatisticsFrom the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health StatisticsAccess to Health CarePart 1: ChildrenJuly 1997U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics

Copyright InformationAll material appearing in this report is in the public domain and may bereproduced or copied without permission; citation as to source, however, isappreciated.Suggested citationSimpson G, Bloom B, Cohen RA, and Parsons PE. Access to health care.Part 1: Children. National Center for Health Statistics. Vital Health Stat 10(196).1997.Library of Congress Catalog Card NumberAccess to health care. Part 1, Children.p. cm. — (Vital and health statistics. Series 10, Data from the NationalHealth Survey ; no. 196) (DHHS publication ; no. (PHS) 97-1524)Includes bibliographical references.ISBN 0-8406-0527-71. Child health services—United States—Statistics. 2. Health servicesaccessibility—United States—Statistics. 3. United States—Statistics, Medical. I.National Center for Health Statistics (U.S.) II. Series. III. Series: DHHSpublication ; no (PHS) 97-1524.RA407.3.A346 no. 196[RJ102]362.1'0973021 s—dc21[362.1'9892'000973]97-21786CIPFor sale by the U.S. Government Printing OfficeSuperintendent of DocumentsMail Stop: SSOPWashington, DC 20402-9328Printed on acid-free paper.

Vital andHealth StatisticsAccess to Health CarePart 1: ChildrenSeries 10:Data From the National HealthSurveyNo. 196U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health StatisticsHyattsville, MarylandJuly 1997DHHS No. (PHS) 97-1524

National Center for Health StatisticsEdward J. Sondik, Ph.D., DirectorJack R. Anderson, Deputy DirectorJack R. Anderson, Acting Associate Director forInternational StatisticsLester R. Curtin, Ph.D., Acting Associate Director forResearch and MethodologyJacob J. Feldman, Ph.D., Associate Director for Analysis,Epidemiology, and Health PromotionGail F. Fisher, Ph.D., Associate Director for Data Standards,Program Development, and Extramural ProgramsEdward L. Hunter, Associate Director for Planning, Budget,and LegislationJennifer H. Madans, Ph.D., Acting Associate Director forVital and Health Statistics SystemsStephen E. Nieberding, Associate Director forManagementCharles J. Rothwell, Associate Director for DataProcessing and ServicesDivision of Health Interview StatisticsAnn M. Hardy, Dr.P.H., Acting DirectorGerry E. Hendershot, Ph.D., Assistant to the Director forData Analysis and DisseminationKathryn Silbersiepe, M.D., Acting Chief, Illness andDisability Statistics BranchAnn M. Hardy, Dr.P.H., Acting Chief, Survey Planning andDevelopment BranchRobert S. Krasowski, Chief, Systems and ProgrammingBranchRobert A. Wright, Chief, Utilization and ExpenditureStatistics Branch

ContentsAbstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regular Source of Medical Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Place of Regular Source of Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Reason for No Regular Source of Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Unmet Medical Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33455Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Appendix I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Sources and Limitations of Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Appendix II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Definition of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Appendix III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Questionnaire Items and Flash Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Figures1.2.3.4.5.Percent of children 0–17 years of age with a regular source of medical care by race and/or ethnicity and familyincome: United States, 1993. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Percent of children 0–17 years of age with a regular source of care by type of health insurance coverage:United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Reason for no regular source of care for children 0–17 years of age: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . 5Percent of children 0–17 years of age with unmet health needs by health insurance status: United States, 1993 . . . . . . . 6Percent of children 0–17 years of age with unmet health needs by family income: United States, 1993 . . . . . . . . . . . . . . 6Detailed Tables1.2.3.4.5.6.7.Percent and standard error of children 0–17 years of age with a regular source of medical care, by age and selecteddemographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Percent and standard error of children 0–17 years of age with private health insurance who have a regular source ofmedical care by age and selected demographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Percent and standard error of children 0–17 years of age with public health insurance who have a regular source ofmedical care by age and selected demographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Percent and standard error of children 0–17 years of age with no health insurance who have a regular source ofmedical care by age and selected demographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Percent of children 0–17 years of age with a regular source of medical care by place of regular source of care andselected demographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Percent of children 0–17 years of age with private health insurance and with a regular source of medical care byplace of regular source of care and selected demographic characteristics: United States, 1993. . . . . . . . . . . . . . . . . . . . .Percent of children 0–17 years of age with public health insurance and with a regular source of medical care byplace of regular source of care and selected demographic characteristics: United States, 1993. . . . . . . . . . . . . . . . . . . . .10121416182022iii

8.9.Percent of children 0–17 years of age with no health insurance and with a regular source of medical care by place ofregular source of care and selected demographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Percent of children 0–17 years of age by selected unmet medical needs and selected demographic characteristics:United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Appendix TableI.ivPercent of children 0–17 years of age with unknown insurance coverage, regular source of medical care, and unmetmedical need by selected demographic characteristics: United States, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

ObjectivesThis report presents nationalestimates of access to medical careand unmet health care needs forchildren through 17 years of age byselected sociodemographic variablesincluding sex, age, race and/orethnicity, family income, familystructure, place of residence, andhealth status. In addition, the impact ofchildren’s health insurance status onaccess to care is described.MethodsData from the 1993 Access to Careand Health Insurance questionnaires ofthe National Health Interview Survey(NHIS) are analyzed to examine accessindicators. The NHIS is a continuinghousehold survey of the civiliannoninstitutionalized population of theUnited States. The sample included16,907 children from infants through 17years of age from 24,071 households.ResultsIn 1993, over 7.3 million U.S.children had at least one unmet healthcare need or had medical care delayedbecause of worry about the cost ofcare. These health care needs includedmedical care, dental care, prescriptionmedicine, glasses, and mental healthcare. In addition, almost 4.2 millionchildren lacked a regular source ofhealth care. Factors related to accessindicators included health insurance,family income, race and/or ethnicity,family structure, and place of residence.The lack of health insurance or inablilityto afford care was the main reasongiven by respondents for childrenlacking a regular source of medicalcare.ConclusionsIn the United States, millions ofchildren do not receive needed healthcare services. Uninsured children andthose in families with low income are atthe greatest risk of having unmet healthneeds.Keywords: child health c access tocare c health insurance c regularsource of care c health careutilization c unmet need c uninsuredAccess to Health CarePart 1: Childrenby Gloria Simpson, M.A.; Barbara Bloom, M.P.A.; Robin A. Cohen,Ph.D.; and P. Ellen Parsons, Ph.D., M.P.H.IntroductionThe health of children dependspartially on their access to health careservices. Despite the improved healthoutlook for U.S. children in this centurybecause of the reduction in infectiousand contagious diseases, recenteconomic and social changes havecalled attention to new challenges tochildren’s health and their need forhealth services. Changes in familystructure, geographic mobility, andeconomic well-being have placed manychildren in need of health servicesresulting from conditions relating tohunger, poor housing conditions,violence, and neglect (1). Since 1975,the number of children living in povertyhas doubled. In addition, today27 percent of U.S. children live in singleparent families (2). Health services andinterventions are needed to deal withcrises such as child abuse, which hasrisen to 850,000 substantiated cases ayear; teen suicides, which have almostdoubled since 1970; and teen homicides,which have doubled in the past decade.In addition, although the rates of manyhealth conditions among children haveremained stable, rates of respiratoryconditions, especially asthma, haveincreased dramatically, andimmunization rates for preschoolchildren remain below recommendedguidelines (2).To meet current and emerginghealth needs of children, the U.S.Maternal and Child Health Bureausponsored the development of newhealth care guidelines (1). Theseguidelines recommend health care visitsfor children at key developmentalstages. These visits should includephysical examinations and medicalintervention, observation, screening, andcounseling. According to theseguidelines, pediatric care, whichemploys preventive andhealth-promoting interventions, will leadto improved outcomes. These outcomesare best ensured by a ‘‘medical home,’’or usual source of health care that isaccessible and offers continuous,comprehensive, family-centered,coordinated, and compassionate care (1).The recent Institute of Medicinereport on Access to Health Care inAmerica defines access to health care as‘‘the timely use of personal healthservices to achieve the best possiblehealth outcomes.’’ (3) Unfortunately,many U.S. children do not have accessto this type of health care. Historically,patterns of pediatric health careutilization have varied by healthinsurance status, income, race and/orethnicity, family structure, and region(4–6).Theoretical and empirical studies ofaccess to health care have emphasizedthe importance of having healthinsurance and a regular source of care toensure that children have access tohealth services (3,7,8). According to thebehavioral model of health services’ useoriginally developed by Andersen (9)and refined over the years (5,10,11),individuals are ‘‘predisposed’’ to usehealth services according to theirdemographic and sociologicalcharacteristics. Having health insuranceand a regular source of care constitute‘‘enabling factors’’ that facilitate the useof health services—the former byproviding financial access and the latterthrough familiarity. According to theliterature, these variables are among thePage 1

Page 2 [ Series 10, No. 196strongest predictors of health serviceuse (8).However, site of the regular sourceof care has also been shown as animportant factor. Not all sources of careare alike. Historically, private doctors’offices have been more likely to providecontinuity of care and the health careservices recommended in the new healthcare guidelines. Public clinics,community health centers, and hospitaloutpatient departments may also providethese services. However, emergencyrooms, while well-equipped to provideemergency care, are not organized toprovide either continuity of care or therange of services that children need(8,12).Beginning in 1993, access to healthcare data has been collected routinelythrough the National Health InterviewSurvey (NHIS). This survey includedmeasures of access to care such asregular source of care, site of that care,and reason for no regular source of care.Also, for the first time in a nationalsurvey, questions were asked aboutunmet needs for health care services.This report presents baseline nationalestimates of the number and percent ofchildren through the age of 17 who havea regular source of care and who haveunmet health needs. Usual source ofcare and place of care are describedaccording to the family’ssociodemographic characteristics or‘‘predisposing’’ characteristics. Data arethen shown by health insurance status.Some differences within healthinsurance categories are also describedfor regular source of care, but not forchildren with unmet health needsbecause the numbers for this crossclassification are unreliable.This report is the first of athree-part set of reports on access tohealth care in the United States for1993. The second report coversworking-aged adults (13), and the thirdreport is on older adults age 65 yearsand over (14). These populations wereexamined separately because they havedifferent health care needs and becausehealth care services are organized totarget the age-specified populationgroups.MethodsThis report on children from infantsthrough 17 years of age uses data fromthe 1993 Access to Care and the 1993Health Insurance questionnaires of theNational Health Interview Survey(NHIS), a continuing household surveyof the civilian noninstitutionalizedpopulation of the United States.Information was collected by personalinterview with an adult in thehousehold.The 1993 Access to Care and theHealth Insurance surveys included16,907 children in the sample. Thesequestionnaires were administered in thethird and fourth quarters of 1993. TheAccess to Care survey includedquestions about regular source of care,place of care, reasons for no regularsource of care, and difficulties in gettinghealth services. The Health Insurancesurvey included questions about type ofinsurance, insurance costs, servicescovered, and reasons for no insurancecoverage. Current Estimates from theNational Health Interview Survey, 1993includes a copy of all questionnaires anda discussion of NHIS sample design,data collection, and data processing(15).Some of the variables analyzed inthis report (regular source of care andunmet need variables) have higher levelsof item nonresponse than usually foundin the NHIS. Missing values for thesevariables have been excluded from theanalysis. This is equivalent to assumingthat missing values are distributed thesame way as the known cases in thepopulation. The percent of cases withunknown or missing responses in thetotal population for the health insurance,the regular source of care, and theunmet need variables are shown intable I of appendix I. Data in table Ishow that uninsured, poor, and minoritypersons were over-represented amongthe unknown cases. This suggests thatthose with missing values are probablymore likely to have access problemsthan known cases. Excluding themissing values probably underestimatesthe problems children have in obtaininghealth care services.Because the estimates shown in thisreport are based on a sample, they aresubject to sampling error, which ismeasured by the standard error. Percentsand standard errors were calculatedusing SUDAAN, a statistical programfor survey data analysis thatincorporates the NHIS sample weightsand complex survey design into itsestimates (16). SUDAAN usesfirst-order Taylor series approximationsto obtain estimates of variances.Standard errors are shown inparentheses for each estimate.A t-test, with a critical value of 1.96(0.05 level), was used to test allcomparisons that are discussed.Statistical tests performed weretwo-tailed tests with no adjustments formultiple comparisons. Terms in the textrelating to differences, such as ‘‘greater’’and ‘‘less,’’ indicate that the differencesare statistically significant, and termssuch as ‘‘similar’’ or ‘‘no difference’’mean that they are not significant. Lackof comment regarding the differencebetween any two estimates does notmean that the difference was tested andfound not to be statistically significant.Race and/or EthnicityIn this report, a child’s race and/orethnicity was based on the respondent’sdescription of each household member’sracial and ethnic background. Childrenwere divided into the following raceand/or ethnicity categories: Whiteincludes white, non-Hispanic children;Black includes black, non-Hispanicchildren; and Hispanic, includesHispanic children of any race. TheHispanic group was subdivided into twocategories: Mexican-American includesMexican-Mexicano, Mexican-American,and Chicano; and Other Hispanicincludes Puerto Rican, Cuban, otherLatin American, other Spanish, andmultiple Hispanic. Children of otherraces who were not of Hispanic originwere included in the totals, but were notshown separately because the numberswere too small for reliable comparisons.If a respondent did not know theethnicity of a household child, that childwas considered not to be of Hispanicorigin.

Series 10, No. 196 [ Page 3Persons were classified into healthinsurance categories based on sixindividual questions about type ofcoverage (private, Medicaid, Medicare,military, Indian Health Service, andother public assistance). Because someindividuals have more than one sourceof insurance, mutually exclusivecategories were developed in order toeliminate analytical problems associatedwith double counting. Categoriesinclude private coverage, publiccoverage, other coverage, and uninsured.More information about this insurancehierarchy is in appendix II.Regular Source and Place ofCareChildren were classified as having aregular or usual source of care if it wasreported that they had at least oneparticular person or place they usuallywent to when sick or needed adviceabout health. Children with a regularsource of care sought medical care in avariety of settings. These places weregrouped into the following fourcategories:Doctor’s offıce—includes privatedoctor’s offices, private doctor’s clinics,HMO’s, and prepaid groups;Clinic—includes company or schoolhealth clinic and/or center; community,migrant, or rural clinic and/or center;county, city, or public county hospitaloutpatient clinic; and private and/orother hospital outpatient clinic;Emergency room—includes hospitalemergency rooms or departments.Other—includes all remainingplaces of care (about 2 percent)—psychiatric, military, other, and unknownfacilities, which were included in thetotal but were not shown separately.Reason for No Regular Sourceof CareWhen children had no regularsource of care, respondents were askedto select the reason from a list ofpossible answers. In this report theresponses were grouped into thefollowing categories:Doesn’t need doctor.No insurance or can not afford it.Unavailable or inconvenient—includes previous doctor who is notavailable and/or has moved; does notknow where to go; and no care isavailable and/or care is too far awayand/or not convenient.Other—includes speaking adifferent language, and other reasons.Unmet NeedRespondents were asked if anyonein the family was unable to obtainneeded medical services in the past 12months. Those who answered ‘‘yes’’ toany of the following series of questionswere classified as having an unmetneed: needed medical care or surgery,but did not get it; delayed medical carebecause of the cost; needed dental care,prescription medicine, eyeglasses, ormental health care, but could not get it.ResultsTables 1–8 present access to careindicators by sociodemographiccharacteristics according to healthinsurance category. Table 1 shows thenumber and percent distribution for allchildren with a regular source of care bysociodemographic characteristics forchildren with all types of insurance;table 2 shows the same information forthose with private insurance; table 3Percent with a regular sourcce of medical careHealth InsuranceLess than 20,000shows the information for those withpublic insurance; and table 4 shows theinformation for children with noinsurance. Tables 5–8 show the numberand percent of children by place of carefor the same characteristics as intables 1–4, and table 9 shows data onunmet health needs for children bysociodemographic variables and healthinsurance status.Regular Source of MedicalCareIn 1993, 94 percent of children inthe U.S. had a regular source of medicalcare; 6 percent (4.2 million) childrenhad no regular source of care (table 1).Family income was an importantvariable associated with children havinga usual source of health care (figure 1).Overall, poor children were at greaterrisk of not having a usual source ofhealth care than wealthier children. Thelikelihood of having a regular source ofcare rose with family income from89 percent for children with annualfamily incomes of less than 20,000 to98 percent for children with familyincomes of 35,000 or more.Differences in having a usual source ofcare by income occurred within eachracial and ethnic group included in thisstudy. For example, among Hispanics,the percent of children having a regularsource of health care ranged from 20,000 34,999 35,000 and over10090800White, non HispanicBlack, non HispanicHispanicRace and/or ethnicitySOURCE: National Center for Health Statistics. National Health Interview Survey, 1993.Figure 1. Percent of children 0–17 years of age with a regular source of medical care byrace and/or ethnicity and family income: United States, 1993

Page 4 [ Series 10, No. 196Figure 2. Percent of children 0–17 years of age with a regular source of care by type ofhealth insurance coverage: United States, 199383 percent for children in families withan annual income of less than 20,000to 97 percent for children in familieswith annual incomes of 35,000 ormore.Overall differences in having ausual source of care existed by race andethnicity. Black and Hispanic childrenwere less likely to have a regular sourceof care than white children. Eighty-sixpercent of Mexican-American childrenand 93 percent of black children had aregular source of health care comparedwith 95 percent of white children.Differences in the percent ofchildren having a usual source of carealso existed by region. Children wholived in the South were less likely tohave a regular source of health care thanchildren living in the Northeast orMidwest. These percents ranged from91 percent for young children in theSouth to 97 percent for those living inthe Northeast.Health insurance played animportant role in children having aregular source of health care (figure 2).Seventy-nine percent of uninsuredchildren had a regular source of carecompared with 94 percent of childrenwith public insurance and 97 of childrenwith private insurance. When examiningdata on younger and older childrenseparately, the differences in having aregular source of health care (whenmeasured) by health insurance statuswere significant for all three agecategories—preschool, infant to age 4,and 5–17 years old.Within the health insurancecategories, there were significantdifferences among children having ausual source of care (when measured)by sociodemographic characteristics. Forchildren who had private healthinsurance, there were small differencesin the proportion of those with a regularsource of care by income category andgeographic region (table 2). Ninety-threepercent of children with privateinsurance living below poverty had ausual source of care compared with97 percent of those living above poverty.In terms of region, 95 percent of thosewith private insurance living in theSouth had a regular source of careversus 99 percent of those living in theNortheast.These differences in having a usualsource of care by income and regionwere also found for children withouthealth insurance (table 4). Thelikelihood of having a regular source ofcare rose with income from 76 percentfor children in families with annualincomes under 20,000 to 89 percent forchildren in families with annual incomesof 35,000 or more. This pattern wassimilar to that found for children withprivate insurance; however, thedifferences were greater for uninsuredchildren. There was also a significantdifference among uninsured children inhaving a regular source of care betweenchildren living below poverty and thoseliving above poverty (74 percent versus83 percent). Also, among uninsuredchildren, there were regional differencesin having a regular source of care.Children living in the South and Westwere less likely to have a regular sourceof care than those living in the Midwestand Northeast (75 percent versus 85 to89 percent).In addition to significant differencesin having a usual source of care amonguninsured children by income andregion, there were differences by raceand/or ethnicity and place of residence.While there was no difference in havinga usual source of care between blackand white uninsured children, both weresignificantly more likely to have a usualsource of care than Hispanic children.Sixty-seven percent of uninsuredHispanic children had a regular sourceof care compared with 82 percent ofblack and 84 percent of white uninsuredchildren. In addition, uninsured childrendiffered by place of residence in havinga usual source of care. Seventy-sevenpercent of uninsured children living in ametropolitan statistical area (MSA) hada usual source of medical care while85 percent of those living in a non-MSAhad usual source of health care.Place of Regular Source ofMedical CareAmong children having a usualplace of care, 84 percent received thatcare in a private doctor’s office,11 percent received it in a clinic, and1 percent used the hospital emergencyroom (ER) (table 5). Importantdifferences in usual place of care existedby race and/or ethnicity, place ofresidence, and family structure. Overall,among white children having a usualplace of care, 92 percent used a privatedoctor’s office compared with 67 percentof black and 70 percent of Hispanicchildren. Conversely, only 5 percent of

Series 10, No. 196 [ Page 5white children used a clinic while25 percent of black and Hispanicchildren used clinics. However, theracial and ethnic differences for childrenin families with incomes over 35,000were not significant.In regard to family structure, therewere differences between children livingwith both parents and those living onlywith their mother. Children living withtwo parents were more likely to go to aprivate doctor than those living onlywith their mother (88 versus 73 percent),and less likely to go to a clinic (8versus 22 percent).When examining central city versusnoncentral city (suburbs), children livingin the central city used clinics as aregular place of care more thansuburban children (20

children had at least one unmet health care need or had medical care delayed because of worry about the cost of care. These health care needs included medical care, dental care, prescription medicine, glasses, and mental health care. In addition, almost 4.2 million children lacked a regular source o

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info@childwelfare.gov https://www.childwelfare.gov. ISSUE BRIEF. May 2015. Health-Care Coverage for Youth in Foster Care— and After. WHAT’S INSIDE. Health-care needs of children and youth in foster care Medicaid coverage— who is eligible and how? Other health-care coverage (non-Medicaid) Coverage benefits Improving health-care coverage .

Primary Health Care Providers Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and

BEAM Team Memo Rosalind Arwas Carolyn Perkins Helen Woodhall A very warm welcome to the March/April 2021 edition of The BEAM. This time last year, the spring edition unexpectedly almost became our last but, as the