Children's Access to Primary Care: Differences by Race, Income, and Insurance Status

OBJECTIVE: Congressional initiatives to reduce spending under major public programs designed to improve access to health care have brought renewed attention to the health care needs of traditionally disadvantaged populations. The objective of this study was to assess access to and use of primary care services for poor, minority, and uninsured children in the United States. DESIGN AND SETTING: We analyzed data on 7578 1- to 17-year-old children of families responding to the 1987 National Medical Expenditure Survey, a nationally representative sample of families and children. OUTCOME MEASURES: Adult respondents were asked to report on several measures of access and use of care for children in the household. These included the presence of a usual source of care and its characteristics (type of site, travel time, waiting time, after-hours care, and availability of a regular physician). We also examined the volume of physician contacts relative to the sample child's health status, the receipt of measles vaccinations, and whether children received care in response to selected symptoms of ill health. Results are presented for children generally and for four subgroups: poor children; minority children; uninsured children; and white, non-poor, insured children (the reference group). RESULTS: Poor, minority, and uninsured children fared consistently worse than the children in the reference group on all indicators studied. For example, children in each of the three at-risk groups were twice as likely as the children in the reference group to lack usual sources of care, nearly twice as likely to wait 60 minutes or more at their sites of care, and used only about half as many physician services after adjusting for health status. Multivariate analyses revealed that poverty, minority status, and absence of insurance exert independent effects on access to and use of primary care. CONCLUSIONS: The existence of substantial barriers to the access to and use of primary care for low-income, minority, and uninsured children is cause for significant concern, especially in an era of program cutbacks. New initiatives are needed to address both financial and non-financial barriers to the receipt of primary care for disenfranchised children.