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A Disturbing Portrait of Uninsured Minority Children: Reasons for

Uninsurance, Parental Awareness of Children’s Uninsured Status, and

Children’s Health, Access to Care, Use of Services, and Quality of CareGlenn Flores, Candy Walker, Hua Lin,

Tony Fierro, Monica Henry, Ken Massey, Alberto Portillo

Division of General Pediatrics

UT Southwestern/Children’s Medical Center Dallas

Funding: NICHD R01

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Disclosure

No relevant financial relationships to disclose or COIs to resolve

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Background Among US children, Latinos at highest risk and

African-Americans at 2nd highest risk of any racial/ethnic group of being uninsured, at 14% and 9% uninsured, respectively, vs. 7% in whites

Number of uninsured Latino children (2.5 million) continues to exceed number of uninsured white children

Latino and African-American children account for 53% of all uninsured children, although comprising only 38% of total population of US children

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Background Not enough known, however, about

Reasons for Medicaid- and CHIP-eligible minority children being uninsured

Parental awareness of minority children’s uninsured status

Uninsured minority children’s health, access to care, use of services, and quality of care

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Study Aim For uninsured but Medicaid- and CHIP-eligible

minority children, to examine: Reasons for being uninsured Parental awareness of child’s uninsured status, Children’s health, access to care, use of

services, and quality of care

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Methods Research design: cross-sectional survey, as part of

randomized, controlled trial of an insurance intervention for uninsured children

Study sites Five communities in Dallas metropolitan area with

highest proportion of uninsured and poor minority children

Recruitment occurred at 91 community sites, including supermarkets, department stores, public libraries, Goodwill stores, food banks, health fairs, Boys and Girls clubs, churches, schools, Laundromats, and housing projects

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Methods Eligibility criteria

Latino or African-American race/ethnicity Age: 0-17 years old No health insurance coverage, and eligible for

but not enrolled in Medicaid or CHIP Residing in Dallas County

Recruitment performed from June 2011 to January 2014 by trained, bilingual Latino and African-American staff

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Methods Characteristics examined (using validated

instruments) included: Sociodemographic characteristics Health status Use of health services Quality of pediatric care (scale of 0-10, where 0 =

worst and 10 = best) Quality of life Parental satisfaction Financial burden

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Results: Sample Characteristics 49,411 potential caregivers screened for eligibility Final sample size consisted of 275 uninsured Latino and

African-American (AA) children eligible for but not enrolled in Medicaid or CHIP

Race/ethnicity: Latinos, 64%; AAs, 36% 96% of caregivers female, 39% married and living with

their spouse, and 32% had limited English proficiency Mean annual family income = $21,864 (range: $1,440-

$64,000). Mean age of uninsured children = 7.3 years (range: 1-18),

51% male, and 95% born in US

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Health-Insurance Characteristics Mean time without insurance = 14 months (range: 1-144) For those ever insured (95%), most frequent reasons for

loss of insurance: Insurance expired and never reapplied (24%) Parent told income too high (13%) Missing paperwork (10%) “Don’t know why” (10%)

Among those never insured (5%), reasons for never having insurance included language barriers, too much hassle, and “move to Texas,” each at 20%

Only 51% of parents aware of their uninsured child’s eligibility for Medicaid or CHIP

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Results: Health Status 40% of children were in suboptimal health (not

excellent/very good) About 2/3 had special healthcare needs 82% of parents reported worrying about their

child’s health more than other people 73% of parents reported worry or concern about

their child’s physical health

12Results: Access to Care andUnmet Needs

Only 37% of children have primary-care provider (PCP)

62% have usual source of preventive care 72% have delayed or did not receive needed

healthcare 53% have not received all needed dental care 90% have not received all needed acute care 12% have not received all needed specialty care 11% have not received all needed vision care

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Results: Quality of Care Parental ratings (scale of 0-10, where 10 = best)

of quality of pediatric care low Overall mean = 4.8 Primary care = 3.6 Specialty care = 2.1 Acute care = 3.9

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Results: Financial Burden 45% of parents reported they needed additional

income to cover child’s medical expenses 35% reported child’s health caused financial

problems for family 23% cut down their work hours to provide

healthcare for their child 10% ceased working because of child’s health

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Comparison of Latino vs. AA Children

Characteristic Latinos AAs P

Worry about child’s health more than other people 89% 73% <.01

No usual source of preventive care 51% 23% <.01

Same source of sick care and preventive care 40% 55% .02

No PCP 70% 52% <.01

Usual source of care has night or weekend hours 7% 21% <.01

Has 24-hour phone coverage for sick care 5% 25% <.01

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Comparison of Latino vs. AA Children

Characteristic Latinos AAs P

Never/sometimes receives help or advice over phone 3% 11% .01

Didn’t receive all needed acute care 5% 18% .01

Didn’t receive all needed prescription medications 7% 15% .03

Didn’t receive all needed vision care 30% 48% <.01

Doctor never/sometimes understands how you prefer to raise child 21% 37% .01

Need additional income to cover child’s medical expenses 39% 55% <.01

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Conclusions About half of parents of uninsured minority

children unaware of their children’s eligibility for Medicaid or CHIP

Uninsured minority children average 14 months without health insurance Some have been uninsured as long as 12 years 10% have never been insured in their lifetime

For uninsured children who have been previously insured, most common obstacle not reapplying after insurance expiration

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Conclusions Many uninsured minority children in poor health,

most have special healthcare needs, and > ¾ of their parents worry about their children’s health more than other people

About 2/3 of uninsured minority children have no PCP, most have delayed or not received all needed health and dental care, many have unmet specialty and vision care needs, and quality-of-care ratings quite low

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Conclusions > 1/3 of parents of uninsured minority children

report child’s health causes financial problems for family 1 in 10 ceased working due to child’s health

Uninsured Latino children at significantly higher risk of Parental worry about child’s health Having no PCP Lacking 24-hour phone coverage for sick care

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Implications Parents of uninsured minority children need better

education and awareness regarding Medicaid/CHIP eligibility and application process

Improvements needed in Medicaid/CHIP outreach and enrollment, such as greater use of known effective interventions, including community health workers and promotoras

Medicaid and CHIP should be maintained or expanded, and efforts to defund CHIP—such as recent House amendment to Continuing Resolution—should be avoided

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Implications There’s urgent need to insure and provide PCPs to

uninsured Latino children Given especially high risk for inefficient, costly

use of ED for care, due to vast majority lacking access to 24-hour phone coverage for sick care