Variation in Access to Care for Low-Income Children with Public Coverage

Variation in Access to Care for Low-Income Children withPublic Coverage:Baseline Findings from the 2002/2003 Los Angeles County Health SurveyChildren’s Health Initiative of Greater Los AngelesPrepared for: Prepared by: Genevieve KenneyJoshua McFeetersJustin YeeOctober 3, 2006 iVariation in Access to Care for Low-Income Childrenwith Public Coverage: A Baseline Analysis with the 2002/2003 Los Angeles County Health SurveyExecutive SummarySince 2003, the Children’s Health Initiative of Greater Los Angeles has sought to reduce uninsurance rates among children in Los Angeles County. Using the2002/2003 Los Angeles County Health Survey to examine the variation in healthcare access and use among children with public coverage prior to the Initiative, itappears that certain subgroups are experiencing problems. The Children’s HealthInitiative of Greater Los Angeles will not have as great an impact on improvingchildren’s health unless these barriers are addressed.ResultsThis analysis focuses exclusively on low-incomechildren with family incomes under 200 percent ofthe federal poverty level that have public coveragethrough Medi-Cal or Healthy Families.Child’s Citizenship Status• The single biggest differentiating factor affectingaccess to care.• Nearly four out of 10 non-citizen children — 38percent — reported difficulty accessing neededmedical care compared to only 17 percent oftheir citizen counterparts.• Cost concerns are a factor. For example, 20 percent of non-citizen children could not afforda medical check-up compared to 7 percent oftheir citizen counterparts.• Likewise, non-citizen children were less likely to have a usual source of care than their citizencounterparts.Child’s Health Status• Children in fair or poor health had more difficultyaccessing needed medical care than did childrenin better health. • Children in fair or poor health were over twiceas likely to have unmet prescription drug needs compared to children in better health(20 percent vs. 8 to 10 percent).• It is possible that some of these unmet needsaffect the child’s health status.Child’s Age• Children between the ages of 12 and 17 weremore likely to have unmet health care needsand were less likely to have received a well-child exam than their younger counterparts.Parental Mental Health• Consistent with other studies, we found that 25 percent of children with depressed parentswere reported to have difficulty accessing neededmedical care compared to only 14 percent ofchildren whose parents were not depressed.Income• Poor children — those with family incomesbelow the federal poverty line — were morelikely to experience transportation and languagebarriers when trying to obtain needed health carethan near-poor children — those with familyincomes at or up to twice the federal poverty line. iiDifficulties Accessing Care Among Low-Income Publicly Insured Children Ages 0-17 in L.A. County by Key Characteristics, 2002/2003Difficulty accessing Transportation barrierLanguage barrierneeded care for childto medical careto medical care1Child’s Citizenship StatusU.S. Citizen^16.7%9.8%10.2%Non-Citizen38.4%***17.6%**24.3%***Child’s Health StatusExcellent 13.7%***8.3%***4.9%***Very Good16.6%***10.7%6.2%***Good17.8%***8.6%**11.9%***Fair/Poor^27.3%14.8%24.6%Child’s Age0-5 16.5%9.1%**13.0%6-1119.9%9.4%*10.5%12-17^18.8%13.5%10.1%Parent’s Mental Health Status2Depressed25.1%***15.3%***18.9%***Not Depressed^14.2%7.3%6.8%Family Income0 to 99% FPL18.1%12.5%***13.4% ***100% to 199% FPL^18.7%7.8%9.0%Child’s Race-EthnicityLatino19.0%9.4%13.4%***White^17.4%13.6%2.2%African-American11.7%16.2%0%Asian-Pacific Islander19.8%11.2%9.6%Other30.3%21.1%0%Functional LimitationsYes32.4%**19.3%*10.4%No^17.3%9.6%11.3%Parent CitizenshipU.S. Citizen^14.9%13.5%3.9%Non-Citizen20.7%***8.2%***16.3%***Parent Foreign-Born StatusForeign Born19.9%***8.6%***14.8%***U.S. Born^13.9%15.6%0.8%Marriage Status of RespondentMarried^19.3%8.4%13.9%Not Married17.1%12.3%**8.6%*** iiiVariation in Access to Care for Low-Income Childrenwith Public Coverage: A Baseline Analysis with the 2002/2003 Los Angeles County Health SurveyExecutive SummaryDifficulty accessing Transportation barrierLanguage barrierneeded care for childto medical careto medical careParent’s EducationLess than High School19.9%9.4%14.3%*High School15.1%11.7%8.1%Some College or trade school18.7%12.6%7.8%College or Postgrad degree^18.8%7.8%8.2%Work Status of RespondentEmployed17.9%8.9%10.3%Unemployed^18.7%11.4%12.2%Language of InterviewEnglish14.0%***14.7%***---Not English^20.4%8.3%16.7%Number of Children in Household2 or fewer18.3%9.9%10.5%3 or more^18.5%11.2%13.0%SPAAntelope Valley16.3%20.9%8.6%San Fernando17.0%11.1%13.1%San Gabriel15.8%8.1%8.9%Metro24.9%10.4%11.0%West^17.9%12.3%8.5%South18.8%9.3%13.6%East15.9%10.1%12.1%South Bay19.1%10.4%9.5%Source: Urban Institute tabulations of the 2002/2003 Los Angeles County Health Survey.Notes: