Health Care Access After Injury by Insurance Type in a Pediatric Population

Abstract

Previous studies demonstrate discrepancies in health care access by insurance status for routine, discretionary care. It is unknown whether these discrepancies in health care utilization by insurance status persist in urgent/emergent circumstances. We used injury as a sentinel event to represent urgent/emergent medical conditions to examine the relationship with insurance type. Using the 2000, 2001, and 2002 National Health Interview Survey, we examined medical care sought after 1847 injuries among children younger than 18 years. We performed univariate analyses to explore the relationship of insurance type and demographic variables with medical care sought. We then conducted multivariate logistical regression analysis to assess the association of insurance type with only making a telephone call and with being hospitalized while controlling for confounding variables. There was no direct measure in injury severity in these data. Although uninsured children had the lowest percentage of head injuries, there was no significant difference in body part injured by insurance type. While controlling for potentially confounding variables, there were no significant differences for making only a telephone call after an injury by insurance type [OR (95% CI): 1.29 (0.45-3.72) for private insurance; 1.13 (0.28-4.62) for other insurance types; 0.69 (0.08-6.33) for uninsured; Medicaid as the reference]. However, uninsured children had a significantly increased likelihood of being hospitalized after an injury [OR (95% CI): 4.07 (1.13-14.66) compared with 2.21 (0.73-6.63) for privately insured; 1.61 (0.47-5.55) for other insurance types; Medicaid as the reference]. While controlling for potentially confounding variables, there was no relationship between type of insurance and only making a telephone call after an injury. However, uninsured children were significantly more likely to be hospitalized after an injury than insured children. This latter relationship differs from overall patterns of health care utilization by insurance type.