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Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling

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Abstract

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002–2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12–1.31); regular exercise (aRR 1.06, 95% CI 1.01–1.12), use of car safety devices (aRR 1.10, 95% CI 1.03–1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05–1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04–1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.

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Acknowledgments

This project received direct support from grant numbers K08 HS16181 and R01 HS018569 from the Agency for Healthcare Research and Quality (AHRQ) and the Oregon Health and Science University Department of Family Medicine. The grant received indirect support from the Oregon Clinical and Translational Research Institute (OCTRI), supported by grant number UL1 RR024140 01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Dr. Pandhi’s time on this project was supported by grant number K08 AG029527 from the National Institute on Aging. These funding agencies had no involvement in the design and conduct of the study; analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. AHRQ collects and manages the Medical Expenditure Panel Survey. Drs. Julie Hudson and Jessica Vistnes from the Agency for Healthcare Research and Quality were extremely helpful in guiding our statistical programming. We are grateful to Drs. Eun Sul Lee and Ed Fryer for sharing their biostatistical expertise.

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Authors and Affiliations

  1. Department of Family Medicine, Oregon Health and Science University, 3181 Sam Jackson Park Rd, Portland, OR, 97239, USA

    Jennifer E. DeVoe & Carrie J. Tillotson

  2. Department of Family Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, U-67, Knoxville, TN, 37920, USA

    Lorraine S. Wallace

  3. Center for Researching Health Outcomes, PO Box 1195, Mercer Island, WA, 98040, USA

    Sarah E. Lesko

  4. Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Court, Madison, WI, 53715, USA

    Nancy Pandhi

Authors
  1. Jennifer E. DeVoe
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  2. Carrie J. Tillotson
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  3. Lorraine S. Wallace
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  4. Sarah E. Lesko
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  5. Nancy Pandhi
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Correspondence to Jennifer E. DeVoe.

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DeVoe, J.E., Tillotson, C.J., Wallace, L.S. et al. Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling. Matern Child Health J 16, 306–315 (2012). https://doi.org/10.1007/s10995-011-0762-4

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