Having Insurance Doesn't Mean Kids Get Proper Health Care

About 13% of parents with health insurance say they have not sought pediatrician-recommended care for their children because of costs, according to a new study.

Bill Spears, PhD, of Wright State University Boonshoft School of Medicine, Xenia, OH, and Mark Rukavina, executive director of the Boston-based Access Project presented data from a study of 1,978 parents at pediatricians’ offices in three counties in Ohio at the American Academy of Pediatrics National Conference and Exhibition. The study found that “parents of children who are covered by private health insurance were more likely than those with public health insurance such as Medicaid or the State Children's Health Insurance Program to report forgoing care such as seeing a recommended specialist, filling a prescription or getting a lab test because of difficulty paying for it,” according to an article published in HealthDay/Bloomberg BusinessWeek.

In the survey—which took place during the summer of 2009, researchers asked parents about their income, type of insurance, and ability to access medical care for their children; about 61% of parents had children covered by private insurance while about 39% had public insurance.

According to the report, Spears and Rukavina uncovered the following information:

• During the previous year, about 5.5% of parents said that their children did not see a recommended specialist, 4.7% did not get a recommended lab test, and 8.7% said they did not fill a prescription due to cost. About 7.8% of parents said their child's health had suffered as a result.
• Around 13% of parents answered "yes" to at least one question and were considered underinsured
• The recession, high unemployment, and increasing costs of care seem to be making things worse; about 17% of parents said it was harder to obtain the treatment their children needed than it was three years ago, including 12.8% of parents with public health insurance and 17.8% of those with private insurance.
• Those having the hardest time getting care were those with household incomes under $74,999 annually.
• Among those with annual household incomes under $15,000, about 30% of those with private insurance were considered underinsured compared to 11.2% of those with public insurance.
• For incomes between $15,000 and $34,999, about 26.2% with private insurance were underinsured compared to 17.7% for those with public insurance.
• In the $35,000 to $74,999 annual income range, about 16.9% of the privately insured were underinsured compared to 8.8% of those with public insurance.
• At income levels over $75,000, about 5.6% of the privately insured were underinsured; none had public insurance.

"People who are in those middle income brackets are saying they are having a harder time taking care of their children's health and their children's health is suffering," said Bill Spears. The jury is still out on whether health reform legislation will alleviate underinsurance, he noted, though much depends on the specifics of the coverage people will be expected to buy.

Far more people will have insurance, but if the coverage they buy has high premiums, deductibles and co-pays, people may continue to find it difficult to pay for care. "If I had to guess, I'd say the underinsurance issue is not going to improve and may get worse," Spears said.

Rukavina, however, believes health reform should help the underinsurance issue. "The expansion of Medicaid will be enormously helpful," he said. "In 2014, the quality of insurance is going to be dramatically improved for most people."

For more information:

• Many Kids Not Getting Recommended Care: Survey
• Health reform leads to drop in child insurance plans
• AAP Works to Implement the Health Reform Law

Will health care reform enable more families to seek pediatrician-recommended care, or is it going to take more than that? What do you think?