Family Care in the United States

OBJECTIVES: The authors describe the epidemiology of family care in the United States. METHODS: A cross-sectional analysis of data from the household component of the 1987 National Medical Expenditure Survey was performed. A representative sample of the civilian, noninstitutionalized US population was analyzed. Participants in the study were all households with at least a mother between the ages of 18 and 55 years and at least one child younger than age 18 (n = 2,975). For this analysis, family care was defined as all families in which there was provider congruence between at least one parent and one child, compared with individual care, defined as families with separate providers. RESULTS: Family care occurred in 35% of families studied. As opposed to individual care, family care was more prevalent in families that resided in non-standard metropolitan statistical area regions and outside of the Northeast, as well as in families whose female heads of household were less educated, older, and had higher unhealthy behavior scores. Except for unhealthy behavior scores, these results remained significant after multivariate adjustment for race, marital status, family income, insurance status, and health care attitudes. Family or general practitioners were more likely than other physicians to provide family care. CONCLUSIONS: Family care occurs in a significant proportion of US families, and location and education are significant determinants of this kind of care. This descriptive epidemiologic analysis of a nationally representative sample provides a foundation for studies examining the cost and quality implications of family care.