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Previous Volume 330:1421-1425 May 19, 1994 Number 20 Next

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ABSTRACT

Background Many children in the United States lack health insurance. We tested the hypothesis that these children are less likely than children with insurance to visit a physician when they have specific conditions for which care is considered to be indicated.

Methods We examined the association between whether children were covered by health insurance and whether they received medical attention from a physician for pharyngitis, acute earache, recurrent ear infections, or asthma. Data were obtained on the subsample of 7578 children and adolescents 1 through 17 years of age who were included in the 1987 National Medical Expenditures Survey, a national probability sample of the civilian, noninstitutionalized population.

Results Uninsured children were more likely than children with health insurance to receive no care from a physician for all four conditions (unadjusted odds ratios, 2.38 for pharyngitis; 2.04 for acute earache; 2.84 for recurrent ear infections; and 1.87 for asthma). Multiple logistic-regression analysis was subsequently used to control for age, sex, family size, race or ethnic group, region of the country, place of residence (rural vs. urban), and household income. After adjustment for these factors, uninsured children remained significantly more likely than insured children to go without a visit to a physician for pharyngitis (adjusted odds ratio, 1.72; 95 percent confidence interval, 1.11 to 2.68), acute earache (1.85; 95 percent confidence interval, 1.15 to 2.99), recurrent ear infections (2.12; 95 percent confidence interval, 1.28 to 3.51), and asthma (1.72; 95 percent confidence interval, 1.05 to 2.83).

Conclusions As compared with children with health insurance, children who lack health insurance are less likely to receive medical care from a physician when it seems reasonably indicated and are therefore at risk for substantial avoidable morbidity.

Source Information

From the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin Medical School, Madison (J.J.S.); the Office of Disease Prevention and Health Promotion, Department of Health and Human Services, Washington, D.C. (R.F.S.); and the Institute for Health Policy Studies and the Department of Pediatrics, University of California, San Francisco (P.W.N.). Presented in part at the annual meeting of the Ambulatory Pediatric Association, Washington, D.C., May 4-6, 1993.

Address reprint requests to Dr. Stoddard at the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin Medical School, H6/4 Clinical Science Ctr., 600 Highland Ave., Madison, WI 53792-4116.

Full Text of this Article

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