Abstract
Background and ObjectivesRecent evidence supports a link between caregivers’ health literacy and their children’s health and use of health services. Disruptions in children’s health insurance coverage have been linked to poor health care and outcomes. We examined young children’s Medicaid enrollment patterns in a well-characterized cohort of child/caregivers dyads and investigated the association of caregivers’ low health literacy with the incidence of enrollment gaps.MethodsWe relied upon Medicaid enrollment data for 1208 children (mean age = 19 months) enrolled in the Carolina Oral Health Literacy project during 2008–09. The median follow-up was 25 months. Health literacy was measured using the Newest Vital Sign (NVS). Analyses relied on descriptive, bivariate, and multivariate methods based on Poisson modeling.FindingsOne-third of children experienced one or more enrollment gaps; most were short in duration (median = 5 months). The risk of gaps was inversely associated with caregivers’ age, with a 2% relative risk decrease for each added year. Low health literacy was associated with a modestly elevated risk increase [Incidence Rate Ratio (IRR) = 1.17 (95% confidence interval (CI) 0.88–1.57)] for enrollment disruptions; however, this estimate was substantially elevated among caregivers with less than a high school education [IRR = 1.52 (95% CI 0.99–2.35); homogeneity p<0.2].ConclusionsOur findings provide initial support for a possible role of caregivers’ health literacy as a determinant of children’s Medicaid enrollment gaps. Although the association between health literacy and enrollment gaps was not confirmed statistically, we found that it was markedly stronger among caregivers with low educational attainment. This population, as well as young caregivers, may be the most vulnerable to the negative effects of low health literacy.
Highlights
Health Insurance Coverage Affects Appropriate Health Care during the First Years of LifeChildren’s health insurance coverage is a major determinant of preventive and continuous health care [1,2,3]
The association between health literacy and enrollment gaps was not confirmed statistically, we found that it was markedly stronger among caregivers with low educational attainment
Parent study sampling frame This investigation utilizes data obtained in the context of the Carolina Oral Health Literacy (COHL) Study, which initially enrolled 1,405 clients of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in seven counties in NC: Brunswick, Buncombe, Burke, New Hanover, Orange, Robeson, and Wake [34]
Summary
Health Insurance Coverage Affects Appropriate Health Care during the First Years of LifeChildren’s health insurance coverage is a major determinant of preventive and continuous health care [1,2,3]. Representative US data confirm that being uninsured is associated with low levels of adherence to professional recommendations for wellchild visits, with the lowest rates found among children eligible but not enrolled in public insurance [9]. This is an important observation because well-child visits and preventive care during the first years of life have demonstrable benefits [10,11,12]. Continuity of care has been linked to favorable health outcomes, including lower emergency department utilization [13]. We examined young children’s Medicaid enrollment patterns in a well-characterized cohort of child/caregivers dyads and investigated the association of caregivers’ low health literacy with the incidence of enrollment gaps
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