Children of working low-income families in California: Does parental work benefit children's insurance status, access, and utilization of primary health care?

Objective. To examine financial and nonfinancial access to care and utiliza tion of primary health care services among children of working low-income f amilies earning below 200 percent of the federal poverty level in Californi a, and to compare them to children in nonworking low-income families and in families earning over 200 percent of poverty. Data Sources/Study Setting. The 1994 National Health interview survey weigh ted to reflect population estimates for California. Study Design. This cross-sectional study of 3,831 children under age 19 foc uses on financial access, that is, the prevalence and continuity of health insurance coverage; structural access, including the presence of a usual so urce of care, the predominant care source, its responsiveness to patient's needs, and any indications of delayed or missed care; and utilization of he alth care measured by the presence of an outpatient doctor's visit and the mean number of visits relative to child health status. Data Collection. The study uses secondary analysis. Findings. Compared to children of nonworking low-income parents and to nonp oor children, children of working low-income parents were more likely to be uninsured (32.1 percent versus 15.6 percent and 10.3 percent, p = .0001) a nd to experience disruptions in insurance coverage (p = .0009). These diffe rences persisted after controlling for other covariates in multivariate ana lyses. Children of working low-income parents did not differ significantly from children of nonworking low-income parents on measures of structural ac cess or utilization, after adjusting for other covariates. However, they di ffered significantly from nonpoor children on structural access and utiliza tion, and these differences mostly persisted after adjusting for other cova riates (odds ratios from 1.5 to 2.9). Similar patterns were observed when c hildren of full-time, year-round working parents with low earnings were com pared with the two reference populations. Conclusion. Children in working low-income families in California have some of the worst access problems. Even full attachment to the workforce does n ot guarantee health insurance benefits, access to care, or improved health care use for children of low-income parents. These children are not better off than other low-income children of nonworking parents and are much worse off than nonpoor children. Expansion of health insurance coverage through Healthy Families and Medi-Cal, and attention to nonfinancial barriers to ca re for working low-income families may help to reduce these disparities.