Access Gaps among Uninsured Children in Los Angeles County

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Abstract

Six out of ten low-income, uninsured children in Los Angeles County had difficulty accessing needed medical care in 2002/2003. Based on the Los Angeles County Health Survey, it appears that L.A.’s Children’s Health Initiative has the potential to improve access to health care services for these children if they enroll in public health programs. This analysis suggests that children enrolled in the Healthy Kids program would have fewer unmet health and dental needs and would be more likely to receive well-child and regular care.

Executive Summary

Los Angeles County is engaged in an ambitious effort to reduce rates of uninsurance among children in the county. Many prior studies have found that, without health insurance, children have lower access to care than to those who have insurance coverage, both nationally and in the state of California (Inkelas et al. 2003; Brown et al. 2004; Davidoff and Rubenstein 2006). In L.A. County, uninsured children were more than four times less likely to have a regular source of health care than children covered by public or private health insurance. Uninsured children were also less likely than insured children to have had a physical exam at the recommended interval (LA Health Department of Health Services 2004). To address the potential access problems experienced by children in L.A. County, the Healthy Kids program was introduced in July 2003. The Healthy Kids program included a coverage expansion to undocumented children and to uninsured children whose incomes were between 250 and 300 percent of the federal poverty level. It also included broader outreach and application assistance efforts aimed at increasing enrollment of uninsured citizen children who could qualify for the existing Medi-Cal and Healthy Families programs. It is hoped that the Healthy Kids Program will improve access to care among the children who gain coverage.

This brief uses the 2002/2003 L.A. County Health Survey (LACHS) to examine the extent to which uninsured children experienced access problems prior to the launch of the Healthy Kids Program and how much access could be improved by enrolling these children in public coverage. We first examine the extent of access problems reported for lowincome, uninsured children in L.A. County and then compare those measures to those found for low-income children covered by Medi-Cal or Healthy Families in the baseline period. Because the composition of low-income children who were uninsured in 2002/2003 differed from that of those with public coverage, we examined access differences between uninsured and publicly insured children, controlling for observed characteristics of the two groups related to race/ethnicity, age, health status of the child and the socioeconomic characteristics of the family. Since these multivariate models yielded results that were comparable to the bivariate findings, we present the bivariate findings.1 For all of the analyses in this brief, we define low-income children as children with family incomes below 200 percent of the federal poverty level (FPL).

This analysis is part of the Healthy Kids Program Evaluation, a four-year effort supported by The California Endowment and First 5 LA. A prior brief used the 2002/2003 survey to examine coverage gaps for children in the baseline period, and subsequent briefs will examine the 2005 LACHS data to assess the extent to which the new Healthy Kids program and renewed outreach efforts appear to be reducing uninsurance among children in L.A. County (Kenney et al. 2006 (a and b)). The evaluation has multiple components, including case studies, focus groups and a longitudinal survey of enrollees. For more information on the evaluation and these studies, see “Healthy Kids” or www.urban.org.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.