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Flores G, Lin H, Walker C, Lee M, Portillo A, Henry M, Fierro M, Massey K. A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs. Int J Equity Health 2016; 15:44. [PMID: 27000795 PMCID: PMC4802608 DOI: 10.1186/s12939-016-0331-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. METHODS For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. RESULTS The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. CONCLUSIONS Half of parents of uninsured minority children are unaware that their children are Medicaid/CHIP-eligible. These uninsured children have suboptimal health, impaired access to care, and major unmet needs. The child's health causes considerable family financial burden, and one in 10 parents ceased work. The study findings indicate urgent needs for better parental education about Medicaid/CHIP, and for improved Medicaid/CHIP outreach and enrollment.
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Affiliation(s)
- Glenn Flores
- Medica Research Institute, MR-CW105, P.O. Box 9310, Minneapolis, MN, 55440-9310, USA.
| | - Hua Lin
- Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Candy Walker
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Michael Lee
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA.,Children's Health System of Texas, Dallas, TX, 75235, USA
| | - Alberto Portillo
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA
| | - Monica Henry
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA
| | - Marco Fierro
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA
| | - Kenneth Massey
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9063, USA
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Piatt JH, Neff DA. Hospital care of childhood traumatic brain injury in the United States, 1997-2009: a neurosurgical perspective. J Neurosurg Pediatr 2012; 10:257-67. [PMID: 22900487 DOI: 10.3171/2012.7.peds11532] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal in this paper was to study hospital care for childhood traumatic brain injury (TBI) in a nationwide population base. METHODS Data were acquired from the Kids' Inpatient Database (KID) for the years 1997, 2000, 2003, 2006, and 2009. Admission for TBI was defined by any ICD-9-CM diagnostic code for TBI. Admission for severe TBI was defined by a principal diagnostic code for TBI and a procedural code for mechanical ventilation; admissions ending in discharge home alive in less than 4 days were excluded. RESULTS Estimated raw and population-based rates of admission for all TBI, for severe TBI, for death from severe TBI, and for major and minor neurosurgical procedures fell steadily during the study period. Median hospital charges for severe TBI rose steadily, even after adjustment for inflation, but estimated nationwide hospital charges were stable. Among 14,932 actual admissions for severe TBI captured in the KID, case mortality was stable through the study period, at 23.9%. In a multivariate analysis, commercial insurance (OR 0.86, CI 0.77-0.95; p = 0.004) and white race (OR 0.78, CI 0.70-0.87; p < 0.0005) were associated with lower mortality rates, but there was no association between these factors and commitment of resources, as measured by hospital charges or rates of major procedures. Increasing median income of home ZIP code was associated with higher hospital charges and higher rates of major and minor procedures. Only 46.8% of admissions for severe TBI were coded for a neurosurgical procedure of any kind. Fewer admissions were coded for minor neurosurgical procedures than anticipated, and the state-by-state variance in rates of minor procedures was twice as great as for major procedures. Possible explanations for the "missing ICP monitors" are discussed. CONCLUSIONS Childhood brain trauma is a shrinking sector of neurosurgical hospital practice. Racial and economic disparities in mortality rates were confirmed in this study, but they were not explained by available metrics of resource commitment. Vigilance is required to continue to supply neurosurgical expertise to the multidisciplinary care process.
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Affiliation(s)
- Joseph H Piatt
- Division of Neurosurgery, A I duPont Hospital for Children, Wilmington, Delaware 19803, USA.
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McDermott S, Zhou L, Mann J. Injury Treatment among Children with Autism or Pervasive Developmental Disorder. J Autism Dev Disord 2007; 38:626-33. [PMID: 17690968 DOI: 10.1007/s10803-007-0426-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 07/18/2007] [Indexed: 10/23/2022]
Abstract
This study examined the differences in the frequency and type of injury for children with autism and pervasive developmental disorder (PDD) compared with typically developing peers, when both groups are insured by Medicaid. The relative rate (RR) of emergency/hospital treatment of injury for children with autism or PDD compared to controls was 1.20 [95% Confidence Interval (CI) 1.04-1.39] after controlling for age and gender. Children with autism or PDD had a higher rate for head, face, and neck injuries (RR 1.47, 95% CI 1.13-1.90) and lower rate for sprains and strains (RR 0.54, 95% CI 0.32-0.91). Treatment for poisoning was 7.6 times as frequent, and self-inflicted injury was also 7.6 times as frequent for children with autism or PDD.
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Affiliation(s)
- Suzanne McDermott
- Department of Family and Preventive Medicine, Family Medicine Center, School of Medicine, University of South Carolina, 3209 Colonial Drive, Columbia, SC 29208, USA.
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