Access to care for poor children. Separate and unequal?

Objective -- to determine how coverage by Medicaid affects the use of care, as well as the location and continuity of care for poor. Design -- analysis of the 1988 National Health Interview Survey on Health. Setting -- nationally representative sample of the US, civilian population. Participants -- a total of 17, 710 under 18 years of age selected in a stratified cluster sampling of US. . . . Main Outcome Measures -- the percentage of children with a usual of routine care; the timeliness of visits for routine care; the usual where routine care is received; and the continuity between sources of. Results -- poor children with Medicaid coverage were more likely than without Medicaid to have a usual source of routine care (91% vs. 78%. . . ) and to receive routine care within an appropriate time interval (84%. 69%. . . ). However, poor children with Medicaid were less likely than living above the poverty line to receive routine care in physicians' (56% vs. 82%. . . ) and more likely to lack continuity between usual of routine and sick care (18% vs. 4%. . . ). Children receiving routine at community clinics compared with children receiving care at physicians' were more likely to receive sick care at a different location than they receive routine care (40% vs 4%. . . ) and also more likely to an emergency department as their usual source of sick care (9% vs. 2%. . . ). Conclusions -- while Medicaid does improve access to care for poor, it does not ensure them access to the same locations and continuity care as that available to other children. Recent changes in the Medicaid may address some of these inequities, but others are likely to.