Medical Care for Children: Public Insurance, Private Insurance, and Racial Differences in Utilization

Abstract

Data from two waves of the Child-Mother module of the National Longitudinal Surveys are used to examine the medical care received by children. We compare those covered by Medicaid, by private health insurance and those with no insurance coverage at all. We find there are substantial differences in the impact of public and private health insurance and these effects also differ between blacks and whites. White children on Medicaid tend to have more doctor checkups than any other children and white children on Medicaid or a private insurance plan have a higher number of doctor visits for illness. In contrast, for black children, neither Medicaid nor private insurance coverage is associated with any advantage in terms of the number of doctor visits for illness. Furthermore, black children with private coverage are no more likely than those with no coverage to have doctor checkups; black Medicaid children are more likely than either group to have checkups although the gap is not precisely estimated. We exploit the longitudinal dimension of the data in order to take account of potential selection and thus include child specific fixed effects in the models. The results are robust to the inclusion of these controls for unobserved heterogeneity. They suggest that private and public health insurance mean different things to different children, and that national insurance coverage will not equalize utilization of care.