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Angier H, Hodes T, Moreno L, O’Malley J, Marino M, DeVoe JE. An observational study of health insured visits for children following Medicaid eligibility expansion for adults among a linked cohort of parents and children. Medicine (Baltimore) 2022; 101:e30809. [PMID: 36197163 PMCID: PMC9509200 DOI: 10.1097/md.0000000000030809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite its focus on adults, the Affordable Care Act (ACA) Medicaid expansion led to increased health insurance enrollment for children in the United States. Previous studies looked at parent and child insurance changes separately, or used a single survey response item to understand changes in health insurance for parents and children. It is, however, important to understand the connection between parent and child insurance changes together (not individually) using data sources that account for insurance over time. Therefore, to understand the association of parental health insurance on their children's coverage, leveraging a cohort of linked families seen in community health centers (CHCs), we used electronic health records to link a cohort of parents and children with ≥1 visit to a CHC in a Medicaid expansion state pre- (1/1/2012-12/31/2013) and ≥1 visit post-ACA (1/1/2014-12/31/2018) and determined primary payer type for all visits. This observational, cohort study assessed the rate of insured visits for children pre- to post-ACA across four parental insurance groups (always insured, gained Medicaid, discontinuously insured, never insured) using Poisson mixed effects models. We included 335 CHCs across 7 United States. Insurance rates were highest (~95 insured visits/100 visits) for children of parents who were always insured; rates were lowest for children of parents who were never insured (~83 insured visits/100 visits). Children with a parent who gained Medicaid had 4.4% more insured visits post- compared to pre-ACA (adjusted relative rates = 1.044, 95% confidence interval: 1.014, 1.074). When comparing changes from pre- to post-ACA between parent insurance groups, children's insured visit rates were significantly higher for children of parents who gained Medicaid (reference) compared to children of parents who were always insured (adjusted ratio of rate ratio: 0.963, confidence interval: 0.935-0.992). Despite differences in Medicaid eligibility for children and adults, health insurance patterns were similar for linked families seen in CHCs. Findings suggest consideration should be paid to parent health insurance options when trying to increase children's coverage.
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Affiliation(s)
- Heather Angier
- Oregon Health & Science University, Portland, OR, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Tahlia Hodes
- Oregon Health & Science University, Portland, OR, USA
| | - Laura Moreno
- Oregon Health & Science University, Portland, OR, USA
| | | | - Miguel Marino
- Oregon Health & Science University, Portland, OR, USA
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Kroshus E, Tandon PS, Zhou C, Johnson AM, Steiner MK, Christakis DA. Problematic Child Media Use During the COVID-19 Pandemic. Pediatrics 2022; 150:188697. [PMID: 35916033 DOI: 10.1542/peds.2021-055190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Assess how family stressors (including structural stressors, social determinants of health inequities, and parent psychological distress) relate to media rule implementation and problematic child media use during the coronavirus disease 2019 pandemic. METHODS Nationally representative survey of 1000 United States parents with at least one 6 to 17 year old child was conducted in October through November 2020. RESULTS Problematic use was greater in families where parents were employed full time, present in the home (eg, working from home), had low levels or formal educational attainment, and were experiencing more psychological distress. Although there was a small decline in the number of media-related rules implemented during the pandemic (fewer parents enforced screen limits on weekdays or weekends or limited screen use at mealtimes), there was no association between rule implementation and problematic media use. CONCLUSIONS Family stressors were associated with problematic child media use during the coronavirus disease 2019 pandemic. As we emerge from the pandemic, it will be important to help parents adjust their family's media practices cognizant of the fact that additional children may have developed problematic screen use behaviors. Such efforts should center the role of structural and social determinants of health inequities on the stressors that families experience and that impact media use.
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Affiliation(s)
- Emily Kroshus
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Pooja S Tandon
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Chuan Zhou
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ashleigh M Johnson
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Mary Kathleen Steiner
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
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Akbari SHA, Rizvi AA, CreveCoeur TS, Han RH, Greenberg JK, Torner J, Brockmeyer DL, Wellons JC, Leonard JR, Mangano FT, Johnston JM, Shah MN, Iskandar BJ, Ahmed R, Tuite GF, Kaufman BA, Daniels DJ, Jackson EM, Grant GA, Powers AK, Couture DE, Adelson PD, Alden TD, Aldana PR, Anderson RCE, Selden NR, Bierbrauer K, Boydston W, Chern JJ, Whitehead WE, Dauser RC, Ellenbogen RG, Ojemann JG, Fuchs HE, Guillaume DJ, Hankinson TC, O'Neill BR, Iantosca M, Oakes WJ, Keating RF, Klimo P, Muhlbauer MS, McComb JG, Menezes AH, Khan NR, Niazi TN, Ragheb J, Shannon CN, Smith JL, Ackerman LL, Jea AH, Maher CO, Narayan P, Albert GW, Stone SSD, Baird LC, Gross NL, Durham SR, Greene S, McKinstry RC, Shimony JS, Strahle JM, Smyth MD, Dacey RG, Park TS, Limbrick DD. Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia. J Neurosurg Pediatr 2021:1-10. [PMID: 34861643 DOI: 10.3171/2021.9.peds2185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM). METHODS The authors used retro- and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes. RESULTS A total of 637 patients met inclusion criteria, and race or ethnicity data were available for 603 (94.7%) patients. A total of 463 (76.8%) were non-Hispanic White (NHW) and 140 (23.2%) were non-White. The non-White patients were older at diagnosis (p = 0.002) and were more likely to have an individualized education plan (p < 0.01). More non-White than NHW patients presented with cerebellar and cranial nerve deficits (i.e., gait ataxia [p = 0.028], nystagmus [p = 0.002], dysconjugate gaze [p = 0.03], hearing loss [p = 0.003], gait instability [p = 0.003], tremor [p = 0.021], or dysmetria [p < 0.001]). Non-White patients had higher rates of skull malformation (p = 0.004), platybasia (p = 0.002), and basilar invagination (p = 0.036). Non-White patients were more likely to be treated at low-volume centers than at high-volume centers (38.7% vs 15.2%; p < 0.01). Non-White patients were older at the time of surgery (p = 0.001) and had longer operative times (p < 0.001), higher estimated blood loss (p < 0.001), and a longer hospital stay (p = 0.04). There were no major group differences in terms of treatments performed or complications. The majority of subjects used private insurance (440, 71.5%), whereas 175 (28.5%) were using Medicaid or self-pay. Private insurance was used in 42.2% of non-White patients compared to 79.8% of NHW patients (p < 0.01). There were no major differences in presentation, treatment, or outcome between insurance groups. In multivariate modeling, non-White patients were more likely to present at an older age after controlling for sex and insurance status (p < 0.01). Non-White and male patients had a longer duration of symptoms before reaching diagnosis (p = 0.033 and 0.004, respectively). CONCLUSIONS Socioeconomic and demographic factors appear to influence the presentation and management of patients with CM-I and SM. Race is associated with age and timing of diagnosis as well as operating room time, estimated blood loss, and length of hospital stay. This exploration of socioeconomic and demographic barriers to care will be useful in understanding how to improve access to pediatric neurosurgical care for patients with CM-I and SM.
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Affiliation(s)
- Syed Hassan A Akbari
- 1Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | | | | - James Torner
- 4Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Douglas L Brockmeyer
- 5Department of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - John C Wellons
- 6Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey R Leonard
- 7Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Francesco T Mangano
- 8Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James M Johnston
- 9Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama
| | - Manish N Shah
- 10Department of Pediatric Surgery and Neurosurgery, The University of Texas McGovern Medical School, Houston, Texas
| | - Bermans J Iskandar
- 11Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Raheel Ahmed
- 11Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gerald F Tuite
- 12Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, Florida
| | - Bruce A Kaufman
- 13Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David J Daniels
- 14Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Eric M Jackson
- 15Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gerald A Grant
- 16Department of Neurosurgery, Stanford Child Health Research Institute, Stanford, California
| | - Alexander K Powers
- 17Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Daniel E Couture
- 17Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - P David Adelson
- 18Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Tord D Alden
- 19Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Philipp R Aldana
- 20Department of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Richard C E Anderson
- 21Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nathan R Selden
- 22Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Karin Bierbrauer
- 8Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William Boydston
- 23Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia
| | - Joshua J Chern
- 23Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia
| | | | - Robert C Dauser
- 24Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Richard G Ellenbogen
- 25Department of Neurosurgery, University of Washington Medicine, Seattle, Washington
| | - Jeffrey G Ojemann
- 25Department of Neurosurgery, University of Washington Medicine, Seattle, Washington
| | - Herbert E Fuchs
- 26Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Daniel J Guillaume
- 27Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Todd C Hankinson
- 28Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | - Brent R O'Neill
- 28Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | - Mark Iantosca
- 1Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - W Jerry Oakes
- 9Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama
| | - Robert F Keating
- 29Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Paul Klimo
- 30Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Michael S Muhlbauer
- 30Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - J Gordon McComb
- 31Division of Neurosurgery, Children's Hospital Los Angeles, California
| | - Arnold H Menezes
- 32Department of Neurosurgery, University of Iowa Hospitals, Iowa City, Iowa
| | - Nickalus R Khan
- 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida
| | - Toba N Niazi
- 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida
| | - John Ragheb
- 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida
| | - Chevis N Shannon
- 6Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jodi L Smith
- 34Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laurie L Ackerman
- 34Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew H Jea
- 34Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cormac O Maher
- 35Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Prithvi Narayan
- 36Department of Neurological Surgery, St. Christopher's Hospital, Philadelphia, Pennsylvania
| | - Gregory W Albert
- 37Department of Neurosurgery, University of Arkansas College of Medicine, Little Rock, Arkansas
| | - Scellig S D Stone
- 38Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts
| | - Lissa C Baird
- 38Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts
| | - Naina L Gross
- 39Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Susan R Durham
- 40Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; and
| | - Stephanie Greene
- 41Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert C McKinstry
- 3Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- 3Radiology, Washington University School of Medicine, St. Louis, Missouri
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Boykin A, Jones K, Miller E. Evaluating the Relationship Between Adolescent Fatherhood and Routine Health Care in a Nationally Representative Sample: A Descriptive, Cross-Sectional Study. J Pediatr Health Care 2021; 35:163-171. [PMID: 33288340 DOI: 10.1016/j.pedhc.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study evaluates whether fatherhood status is associated with receipt of preventive care (i.e., a routine physical) among adolescent males and whether attending their child's appointments is associated with greater odds of preventive care. METHOD This study is a secondary analysis of cross-sectional data collected from the 2011-2017 National Survey of Family Growth. The sample consisted of 3,831 males aged 15-21 years. Logistic regression models were constructed to assess the odds of having a routine physical in the previous year. RESULTS Adolescent fatherhood (adjusted odds ratio = 0.56, 95% confidence interval = [0.32, 0.99]) was associated with reduced odds of having a routine physical in the previous year. Attending a child's appointment was not associated with having a routine physical in the previous year (adjusted odds ratio = 0.18, 95% confidence interval = [0.01, 2.31]). DISCUSSION Having a child is associated with foregoing routine physical care in the previous 12 months. Elucidating barriers may inform interventions to increase the uptake of preventive care for adolescent fathers.
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Soylu TG, Elashkar E, Aloudah F, Ahmed M, Kitsantas P. Racial/ethnic differences in health insurance adequacy and consistency among children: Evidence from the 2011/12 National Survey of Children's Health. J Public Health Res 2018; 7:1280. [PMID: 29780766 PMCID: PMC5941257 DOI: 10.4081/jphr.2018.1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/14/2018] [Indexed: 11/23/2022] Open
Abstract
Background Surveillance 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 methods We 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. Results Stratified 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. Conclusions This 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.
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Affiliation(s)
- Tulay G Soylu
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Eman Elashkar
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Fatemah Aloudah
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Munir Ahmed
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
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Jenkins JM. Healthy and Ready to Learn: Effects of a School-Based Public Health Insurance Outreach Program for Kindergarten-Aged Children. THE JOURNAL OF SCHOOL HEALTH 2018; 88:44-53. [PMID: 29224224 DOI: 10.1111/josh.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/26/2017] [Accepted: 05/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school-based health insurance outreach initiative, "Healthy and Ready to Learn," aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina. METHODS Regression discontinuity design and difference-in-differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well-child visits; secondary outcome). Focus groups and key-informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment. RESULTS The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the RD models, but not differences-in-differences, and did not significantly increase well-child visits. CONCLUSIONS Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents.
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Affiliation(s)
- Jade Marcus Jenkins
- School of Education, University of California, 3200 Education, Irvine, CA 92697-5500
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Shen Y, Moore A, Yang PQ, Yeatts DE. Family, neighbourhood, and children’s health: Trends and racial/ethnic disparities between 2003 and 2007 in the U.S. Glob Public Health 2017; 12:970-987. [DOI: 10.1080/17441692.2016.1172101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Yuying Shen
- Department of Sociology, Norfolk State University, Norfolk, VA, USA
| | - Ami Moore
- Department of Sociology, University of North Texas, Denton, TX, USA
| | - Philip Q. Yang
- Department of Sociology, Texas Woman’s University, Denton, TX, USA
| | - Dale E. Yeatts
- Department of Sociology, University of North Texas, Denton, TX, USA
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Akobirshoev I, Bowser D, Parish SL, Thomas C, Bachman SS. Does Parental Health Mediate the Relationship between Parental Uninsurance and Insured Children's Health Outcomes? Evidence from a U.S. National Survey. HEALTH & SOCIAL WORK 2017; 42:e68-e76. [PMID: 28339895 DOI: 10.1093/hsw/hlx003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
Although the United States has made great strides in ensuring near universal health care access for children, the health insurance coverage gap between children and their parents remains high. This study analyzed aggregated data from the 2006-2013 National Health Interview Survey to investigate the direct relationships between parental uninsurance and children's health outcomes. Authors explored how parental health mediates the relationship between parents' health and children's health outcomes. Results suggest that insured children of uninsured parents have worse health status and are at higher risk of asthma, attention-deficit/hyperactivity disorder, developmental delays, learning disabilities, and mental disabilities compared with insured children of insured parents. Parental health mediated this relationship. These findings illuminate the pathway between parental uninsurance and child health outcomes and suggest that policies that provide health insurance coverage to both children and their parents may improve both parental health and children's health outcomes. This study fills an important gap in the literature related to how parental uninsurance affects children's health outcomes mediated by the impact of uninsurance on parental health.
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Affiliation(s)
- Ilhom Akobirshoev
- MS Program in Global Health Policy and Management, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Bouvé College of Health Sciences, Northeastern University, Boston. Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Center for Innovation in Social Work and Health, and School of Social Work, Boston University
| | - Diana Bowser
- MS Program in Global Health Policy and Management, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Bouvé College of Health Sciences, Northeastern University, Boston. Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Center for Innovation in Social Work and Health, and School of Social Work, Boston University
| | - Susan L Parish
- MS Program in Global Health Policy and Management, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Bouvé College of Health Sciences, Northeastern University, Boston. Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Center for Innovation in Social Work and Health, and School of Social Work, Boston University
| | - Cindy Thomas
- MS Program in Global Health Policy and Management, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Bouvé College of Health Sciences, Northeastern University, Boston. Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Center for Innovation in Social Work and Health, and School of Social Work, Boston University
| | - Sara S Bachman
- MS Program in Global Health Policy and Management, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Bouvé College of Health Sciences, Northeastern University, Boston. Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Center for Innovation in Social Work and Health, and School of Social Work, Boston University
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Strane D, French B, Eder J, Wong CA, Noonan KG, Rubin DM. Low-Income Working Families With Employer-Sponsored Insurance Turn To Public Insurance For Their Children. Health Aff (Millwood) 2016; 35:2302-2309. [DOI: 10.1377/hlthaff.2016.0381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Douglas Strane
- Douglas Strane is a clinical research associate at PolicyLab at the Children’s Hospital of Philadelphia (CHOP), in Pennsylvania
| | - Benjamin French
- Benjamin French is an associate professor in the Department of Biostatistics and Epidemiology, Perelman School of Medicine, at the University of Pennsylvania, in Philadelphia
| | - Jennifer Eder
- Jennifer Eder is a consultant at Manatt Phelps & Phillips in New York City. At the time of this research, she was chief policy officer at PolicyLab at CHOP
| | - Charlene A. Wong
- Charlene A. Wong is a pediatrician in the Department of Adolescent Medicine at CHOP and the University of Pennsylvania
| | | | - David M. Rubin
- David M. Rubin is director of PolicyLab and medical director of population health, both at CHOP, and a professor of pediatrics at the Perelman School of Medicine, University of Pennsylvania
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Abstract
Children with insurance have better access to care and health outcomes if their parents also have insurance. However, little is known about whether the type of parental insurance matters. This study attempts to determine whether the type of parental insurance affects the access to health care services of children.I used data from the 2009-2013 Medical Expenditure Panel Survey and estimated multivariate logistic regressions (N = 26,152). I estimated how family insurance coverage affects the probability that children have a usual source of care, well-child visits in the past year, unmet medical and prescription needs, less than 1 dental visit per year, and unmet dental needs.Children in families with mixed insurance (child publicly insured and parent privately insured) were less likely to have a well-child visit than children in privately insured families (odds ratio = 0.86, 95% confidence interval 0.76-0.98). When restricting the sample to publicly insured children, children with privately insured parents were less likely to have a well-child visit (odds ratio = 0.82, 95% confidence interval 0.73-0.92), less likely to have a usual source of care (odds ratio = 0.79, 95% confidence interval 0.67-0.94), and more likely to have unmet dental needs (odds ratio = 1.68, 95% confidence interval 1.10-2.58).Children in families with mixed insurance tend to fare poorly compared to children in publicly insured families. This may indicate that children in these families may be underinsured. Expanding parental eligibility for public insurance or subsidizing private insurance for children would potentially improve their access to preventive care.
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Affiliation(s)
- Christian King
- Department of Nutrition and Health Sciences, University of Nebraska–Lincoln, Lincoln, Nebraska
- Correspondence: Christian King, Department of Nutrition and Health Sciences, University of Nebraska–Lincoln, 104I Ruth Leverton Hall, Lincoln 68583, Nebraska (e-mail: )
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11
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Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways. Matern Child Health J 2015. [DOI: 10.1007/s10995-015-1784-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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DeVoe JE, Marino M, Angier H, O’Malley JP, Crawford C, Nelson C, Tillotson CJ, Bailey SR, Gallia C, Gold R. Effect of expanding medicaid for parents on children's health insurance coverage: lessons from the Oregon experiment. JAMA Pediatr 2015; 169:e143145. [PMID: 25561041 PMCID: PMC4918752 DOI: 10.1001/jamapediatrics.2014.3145] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance. Oregon's randomized Medicaid expansion for adults, known as the Oregon Experiment, created a rare opportunity to assess causality between parent and child coverage. OBJECTIVE To estimate the effect on a child's health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage. DESIGN, SETTING, AND PARTICIPANTS Oregon Experiment randomized natural experiment assessing the results of Oregon's 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child's Medicaid or Children's Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children's coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14409 children aged 2 to 18 years whose parents participated in the Oregon Experiment. EXPOSURES For intent-to-treat analyses, the date a parent was selected to apply for Medicaid was considered the date the child was exposed to the intervention. In per-protocol analyses, exposure was defined as whether a selected parent obtained Medicaid. MAIN OUTCOMES AND MEASURES Children's Medicaid or CHIP coverage, assessed monthly and in 6-month intervals relative to their parent's selection date. RESULTS In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent's selection compared with children whose parents were not selected (adjusted odds ratio [AOR]=1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR=1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR=1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR=2.37; 95% CI, 2.14-2.64). CONCLUSIONS AND RELEVANCE Children's odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents' access to Medicaid coverage and their children's coverage.
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Affiliation(s)
- Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland2OCHIN, Inc, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Jean P. O’Malley
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Courtney Crawford
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Carrie J. Tillotson
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Steffani R. Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Charles Gallia
- Office of Health Analytics, Oregon Health Authority, Portland
| | - Rachel Gold
- OCHIN, Inc, Portland, Oregon5Kaiser Permanente Center for Health Research, Portland, Oregon
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Angier H, Hoopes M, Gold R, Bailey SR, Cottrell EK, Heintzman J, Marino M, DeVoe JE. An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Ann Fam Med 2015; 13:10-6. [PMID: 25583886 PMCID: PMC4291259 DOI: 10.1370/afm.1741] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The Affordable Care Act of 2010 supports marked expansions in Medicaid coverage in the United States. As of January 1, 2014, a total of 25 states and the District of Columbia expanded their Medicaid programs. We tested the hypothesis that rates of uninsured safety net clinic visits would significantly decrease in states that implemented Medicaid expansion, compared with states that did not. METHODS We undertook a longitudinal observational study of coverage status for adult visits in community health centers, from 12 months before Medicaid expansion (January 1, 2013 to December 31, 2013) through 6 months after expansion (January 1, 2014 to June 30, 2014). We analyzed data from 156 clinics in the OCHIN practice-based research network, with a shared electronic health record, located in 9 states (5 expanded Medicaid coverage and 4 did not). RESULTS Analyses were based on 333,655 nonpregnant adult patients and their 1,276,298 in-person billed encounters. Overall, clinics in the expansion states had a 40% decrease in the rate of uninsured visits in the postexpansion period and a 36% increase in the rate of Medicaid-covered visits. In contrast, clinics in the nonexpansion states had a significant 16% decline in the rate of uninsured visits but no change in the rate of Medicaid-covered visits. CONCLUSIONS There was a substantial decrease in uninsured community health center visits and a significant increase in Medicaid-covered visits in study clinics in states that expanded Medicaid in 2014, whereas study clinics in states opting out of the expansion continued to have a high rate of uninsured visits. These findings suggest that Affordable Care Act-related Medicaid expansions have successfully decreased the number of uninsured safety net patients in the United States.
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Affiliation(s)
| | | | - Rachel Gold
- OCHIN, Inc, Portland, Oregon Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - Erika K Cottrell
- Oregon Health & Science University, Portland, Oregon OCHIN, Inc, Portland, Oregon
| | | | - Miguel Marino
- Oregon Health & Science University, Portland, Oregon
| | - Jennifer E DeVoe
- Oregon Health & Science University, Portland, Oregon OCHIN, Inc, Portland, Oregon
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14
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Chen JH. Asthma and child behavioral skills: does family socioeconomic status matter? Soc Sci Med 2014; 115:38-48. [PMID: 24937327 DOI: 10.1016/j.socscimed.2014.05.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
Asthma is associated with poorer behavioral and psychological outcomes in children, yet little is known about whether and how the social stratification process affects the impacts of asthma on children's outcomes. Using data from the Early Childhood Longitudinal Study-Birth Cohort, this study considered the role of socioeconomic status in shaping the developmental consequences of children's asthma. Results showed that asthma was negatively associated with attention and social competence and positively associated with externalizing problem behaviors for children with low-educated mothers and children who lived in poor households. However, the adverse consequences of asthma disappeared for children with high-educated mothers and children who did not experience poverty. Additionally, the socioeconomic disparities were not fully explained by healthcare resources, family process, and exposure to environment risks and the disparities were found for both mild and severe cases. These findings suggest that, to fully understand the developmental consequences of illness in children, it is important to place socioeconomic status at the center of investigation.
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Affiliation(s)
- Jen-Hao Chen
- University of Missouri, Department of Health Sciences, Columbia, MO 65211, United States.
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15
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DeVoe JE, Gold R, Cottrell E, Bauer V, Brickman A, Puro J, Nelson C, Mayer KH, Sears A, Burdick T, Merrell J, Matthews P, Fields S. The ADVANCE network: accelerating data value across a national community health center network. J Am Med Inform Assoc 2014; 21:591-5. [PMID: 24821740 PMCID: PMC4078289 DOI: 10.1136/amiajnl-2014-002744] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network (CDRN) is led by the OCHIN Community Health Information Network in partnership with Health Choice Network and Fenway Health. The ADVANCE CDRN will ‘horizontally’ integrate outpatient electronic health record data for over one million federally qualified health center patients, and ‘vertically’ integrate hospital, health plan, and community data for these patients, often under-represented in research studies. Patient investigators, community investigators, and academic investigators with diverse expertise will work together to meet project goals related to data integration, patient engagement and recruitment, and the development of streamlined regulatory policies. By enhancing the data and research infrastructure of participating organizations, the ADVANCE CDRN will serve as a ‘community laboratory’ for including disadvantaged and vulnerable patients in patient-centered outcomes research that is aligned with the priorities of patients, clinics, and communities in our network.
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Affiliation(s)
- Jennifer E DeVoe
- OCHIN, Inc, Portland, Oregon, USA Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rachel Gold
- OCHIN, Inc, Portland, Oregon, USA Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Erika Cottrell
- OCHIN, Inc, Portland, Oregon, USA Health Choice Network, Miami, Florida, USA
| | | | | | - Jon Puro
- OCHIN, Inc, Portland, Oregon, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA HIV Prevention Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Tim Burdick
- OCHIN, Inc, Portland, Oregon, USA Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | | | | | - Scott Fields
- OCHIN, Inc, Portland, Oregon, USA Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
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16
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DeVoe JE, Tillotson CJ, Angier H, Wallace LS. Recent health insurance trends for US families: children gain while parents lose. Matern Child Health J 2014; 18:1007-16. [PMID: 23817728 PMCID: PMC4918757 DOI: 10.1007/s10995-013-1329-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine--qualitatively and quantitatively--the impact of changing health insurance coverage on US families. Primary data from interviews with Oregon families (2008-2010) were analyzed using an iterative process. Qualitative findings guided quantitative analyses of secondary data from the nationally-representative Medical Expenditure Panel Survey (MEPS) (1998-2009); we used Joinpoint Regression to assess average annual percent changes (AAPC) in health insurance trends, examining child and parent status and type of coverage stratified by income. Interviewees reported that although children gained coverage, parents lost coverage. MEPS analyses confirmed this trend; the percentage of children uninsured all year decreased from 9.6 % in 1998 to 6.1 % in 2009; AAPC = -3.1 % (95 % confidence interval [CI] from -5.1 to -1.0), while the percentage of parents uninsured all year rose from 13.6 % in 1998 to 17.1 % in 2009, AAPC = 2.7 % (95 % CI 1.8-3.7). Low-income families experienced the most significant changes in coverage. Between 1998 and 2009, as US children gained health insurance, their parents lost coverage. Children's health is adversely affected when parents are uninsured. Investigation beyond children's coverage rates is needed to understand how health insurance policies and changing health insurance coverage trends are impacting children's health.
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Affiliation(s)
- Jennifer E DeVoe
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA,
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