Health: Children and Nonelderly Adults with No Usual Source of Health Care

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People who lack a regular source of health care may not receive services when they need them, leading to missed diagnoses, untreated conditions, and adverse health outcomes. Maintaining regular contact with a health services provider can be difficult for low-income people, who are less likely to have health insurance coverage. People without insurance often rely on hospital emergency rooms, which can raise overall costs and lessen continuity of care.

To determine the percentage of children and nonelderly adults with no usual source of health care, adults were asked whether they and their children had a regular place or provider of care and where they received care. Those who reported that they had no regular provider or that they went to a hospital emergency room when they needed health services were defined as having no usual source of care. This was in contrast to individuals who reported that they received care at a doctor's office, a health maintenance organization (HMO), or a clinic.

Nationally, adults were much more likely than children to have no usual source of care: 18 percent versus 6 percent, a statistically significant difference. This pattern held regardless of family income. However, there were large differences among adults and children across income groups. Adults in families with low incomes (under 200 percent of the federal poverty level) were almost twice as likely to lack a usual source of care as adults in higher-income families—27 percent compared to 14 percent. The disparity across income groups was even greater for children, with 10 percent of those in low-income families having no usual source of care versus 3 percent of those in higher-income families. Both of these differences are statistically significant.

Among the 13 states surveyed, there was little variation in the percentage of higher-income children who lacked a usual source of care. Only three states (Massachusetts, Minnesota, and Wisconsin) were lower than the national average of 3 percent, and no state was higher. In contrast, the percentage of children in low-income families with no usual source of care was above the national average of 10 percent in four states (Alabama, California, Florida, and Texas), with low-income children in Texas almost twice as likely as low-income children nationally to lack a usual source of care.

The percentage of low-income adults with no usual source of care also varied considerably by state. In California and Texas, more than one-third had no usual source of care, a higher proportion than the national average. The percentage of low-income adults with no usual source of care was below the national average of 27 percent in Michigan, Minnesota, Mississippi, Washington, and Wisconsin.

Note: The Portable Document Format (PDF) of this report includes all tables and charts.

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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