Racial/ethnic differences in health insurance adequacy and consistency among children: Evidence from the 2011/12 National Survey of Children's Health.

Abstract

BackgroundSurveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children’s (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months).Design and methodsWe used data from the 2011/2012 National Survey of Children’s Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups.ResultsStratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage.ConclusionsThis study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations.Significance for public healthAs the number of minority US children increases, monitoring racial/ethnic differences in health insurance coverage becomes critical in creating insurance programs that can provide adequate and consistent coverage. Using a nationally representative sample, the findings of this study suggest that low income and poor maternal health can adversely affect insurance consistency and adequacy for both minority and white children. This indicates that research studies on inequalities of healthcare coverage should also focus on underserved white populations of children as their insurance coverage is affected by similar factors as those for minority children. Elimination of inequalities may require targeted interventions that include the well-being of the entire family, cross-cultural education of healthcare providers, policy changes to grant low-income children with appropriate and reliable health insurance, and an ongoing monitoring of disparities by health plans.