Variation in Access to Care for Low-Income Children with Public Coverage

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Abstract

Since 2003, the Children's Health Initiative of Greater Los Angeles has sought to reduce uninsurance rates among children in Los Angeles County. Using the 2002/2003 Los Angeles County Health Survey to examine the variation in health care access and use among children with public coverage prior to the Initiative, it appears that certain subgroups are experiencing problems. The Children's Health Initiative of Greater Los Angeles will not have as great an impact on improving children's health unless these barriers are addressed.

Introduction

Los Angeles County is attempting to make great strides in reducing uninsurance rates for children through its Healthy Kids initiative, which was introduced in July of 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. The initiative included expanded outreach and application assistance with the goal of enrolling more uninsured children who are already eligible for the existing Medi-Cal and Healthy Families programs. Several studies have shown that children with public health insurance in California and nationally have better access to health care than children who are uninsured (Inkelas et al. 2003; Brown et al. 2004; Davidoff and Rubenstein 2006). However, other studies have shown that access disparities exist among children who have public coverage. (Kenney, Rubenstein, et. al. Chap 3 2005; Ku and Matani 2001). For the Healthy Kids initiative to realize significant improvements in children's health, it will require both enrolling uninsured children in public health insurance programs and providing access to needed care for those who enroll.

This brief uses the 2002/2003 L.A. County Health Survey (LACHS) to examine the variation in health care access and use among children with public coverage prior to the rollout of Healthy Kids. We assess the extent to which different sub-groups of children already enrolled in public programs experienced problems obtaining needed care prior the launch of the Healthy Kids Program. Access to care among publicly insured children was assessed based on a child's citizenship status, age, health status, the parent's mental health status, and income among other factors. Multivariate analyses also were conducted to study differences in access to care and unmet health needs among the different subgroups, controlling for other factors. In most cases, the multivariate findings produced results that were similar to the bivarate findings. Therefore, we focus on the bivariate findings, and note the bivariate findings that do not hold up in the multivariate model.

This analysis is part of the Healthy Kids Program Evaluation, a four-year effort directed by The Urban Institute and supported by The California Endowment and First 5 LA. Prior briefs have used the 2002/2003 survey to examine coverage and access to care gaps for children in the baseline period in Los Angeles County (Kenney et. al. 2006 (a and b)), 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 Los Angeles County. This evaluation has multiple components, including case studies, focus groups, and a longitudinal survey of enrollees. Read the studies already published as part of the evaluation.

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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.

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