Black and white middle class children who have private health insurance inthe United States

Objective. To compare the health, behavior and school problems, and use of medical, mental health, and special education services of privately insured , middle class black and white children in the United States. Design/Methods. Analyses of the Child Health Supplement to the 1988 Nationa l Health Interview Survey, with a nationally representative sample of 17 11 0 children age 0-17 years. Results. Privately insured middle class black children had fewer chronic he alth conditions, but were less likely to be reported to be in excellent hea lth (46.2% vs 57.3%) and more likely to have had asthma (8.5% vs 5.8%) or t o have been of low birth weight (10.7% vs 5.6%), There were no differences in rates of having a usual source of routine care (92.2% vs 93.8%) or of be ing up to date with well-child care (79.3% vs 78.2%), but black children ma de fewer physician visits, were less likely to use physicians' offices, wer e more likely to lack continuity of care, and were twice as likely to use e mergency departments. These differences in use of medical services persiste d in multivariate analyses and analyses restricted to more affluent childre n. Despite similar rates of behavior problems, black children were more lik ely to repeat a grade (20.0% vs 12.3%) and to have been suspended from scho ol (11.3% vs 5.0%), Although significantly fewer black middle class childre n received mental health or special education services in bivariate analyse s, no differences in receipt of these services were noted in multivariate a nalyses. All differences reported were significant. Conclusions. Among middle class children in the United States, black and wh ite children have similar rates of health and behavior problems, but black children experience substantially increased rates of asthma, low birth weig ht, and school difficulties. Although not differing in the receipt of menta l health or special education services, middle class black children, even i n the presence of private health insurance, have markedly different sources and patterns of use of medical services.