DETERMINANTS OF CHILDRENS HEALTH-CARE USE - AN INVESTIGATION OF PSYCHOSOCIAL FACTORS

Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contributi on of child health need, mental health, and social functioning; matern al mental health, social support and health care utilization; and fami ly functioning and life events. Mothers reported on the 450 participat ing children. Health care visits for a two-year retrospective period w ere obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminate d high users from low users of care. Family conflict was associated wi th a higher volume of care, while children's depressive symptoms and n on-white race were related to lower use. Maternal social support, ment al health, and life events were not predictive of use in either full m ultivariate model. Enabling factors were held relatively constant by p articipation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in pre vious studies of children's health care use. When included in a compre hensive analysis, child and family psychosocial characteristics help t o explain children's health care use beyond what is possible using sim ple health and illness variables. The implications of these findings i n the development of further research and to the practice of routine p ediatric care are discussed.