THE ROLE OF MEDICAID IN ENSURING CHILDRENS ACCESS TO CARE

Context.-Congress enacted a series of laws beginning in the mid 1980s to expand Medicaid eligibility for children, especially those in poor families. As a result, Medicaid enrollment of children has nearly doub led over the past decade. Objective.-To assess the effectiveness of Me dicaid in improving access to and use of health services by poor child ren. Design-Analysis of cross-sectional survey data from the 1995 Nati onal Health Interview Survey. Poor children with Medicaid were compare d to poor children without insurance and nonpoor children with private insurance. Setting and Participants.-A total of 29711 children younge r than 18 years (3716 poor children with Medicaid, 1329 poor children without insurance, 14 609 nonpoor children with private insurance, and 10 057 children with other combinations of poverty and insurance stat us) included in a nationally representative stratified probability sam ple of the US noninstitutionalized population. Main Outcome Measures.- Usual source of care, access to a regular clinician, unmet health need s, and use of physician services. Results.-Poor children with Medicaid compared to poor children without health insurance experienced superi or access across all measured dimensions of health care, including pre sence of a usual source of care (95.6% vs 73.8%), frequency of unmet h ealth needs (2.1% vs 5.9%), and use of medical services (eg, greater t han or equal to 1 physician contact in past year) (83.9% vs 60.7%). Po or children with Medicaid compared to nonpoor children with private in surance used similar levels of physician services (83.9% vs 84%), but were more likely to have unmet health needs (2.1% vs 0.6%) and were le ss likely to have a usual source of care (95.6% vs 97.4%). Conclusion. -Medicaid is associated with improvements in access to care and use of services. However, there remains room for improvement when Medicaid i s judged against private health insurance. The Balanced Budget Act of 1997 contains several Medicaid provisions that could stimulate further improvements in access for poor children.