HEALTH-INSURANCE STATUS AND AMBULATORY CARE FOR CHILDREN

Background. Many children in the United States lack health insurance. We tested the hypothesis that these children are less likely than chil dren with insurance to visit a physician when they have specific condi tions for which care is considered to be indicated. Methods. We examin ed the association between whether children were covered by health ins urance and whether they received medical attention from a physician fo r pharyngitis, acute earache, recurrent ear infections, or asthma. Dat a were obtained on the subsample of 7578 children and adolescents 1 th rough 17 years of age who were included in the 1987 National Medical E xpenditures Survey, a national probability sample of the civilian, non institutionalized population. Results. Uninsured children were more li kely than children with health insurance to receive no care from a phy sician for all four conditions (unadjusted odds ratios, 2.38 for phary ngitis; 2.04 for acute earache; 2.84 for recurrent ear infections; and 1.87 for asthma). Multiple logistic-regression analysis was subsequen tly used to control for age, sex, family size, race or ethnic group, r egion of the country, place of residence (rural vs. urban), and househ old income. After adjustment for these factors, uninsured children rem ained significantly more likely than insured children to go without a visit to a physician for pharyngitis (adjusted odds ratio, 1.72; 95 pe rcent confidence interval, 1.11 to 2.68), acute earache (1..85; 95 per cent confidence interval, 1.15 to 2.99), recurrent ear infections (2.1 2; 95 percent confidence interval, 1.28 to 3.51), and asthma (1.72; 95 percent confidence interval, 1.05 to 2.83). Conclusions. As compared with children with health insurance, children who lack health insuranc e are less likely to receive medical care from a physician when it see ms reasonably indicated and are therefore at risk for substantial avoi dable morbidity.