Maternal and Child Health Journal

, Volume 16, Issue 2, pp 306–315

Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling


    • Department of Family MedicineOregon Health and Science University
  • Carrie J. Tillotson
    • Department of Family MedicineOregon Health and Science University
  • Lorraine S. Wallace
    • Department of Family MedicineUniversity of Tennessee Graduate School of Medicine
  • Sarah E. Lesko
    • Center for Researching Health Outcomes
  • Nancy Pandhi
    • Department of Family MedicineUniversity of Wisconsin-Madison

DOI: 10.1007/s10995-011-0762-4

Cite this article as:
DeVoe, J.E., Tillotson, C.J., Wallace, L.S. et al. Matern Child Health J (2012) 16: 306. doi:10.1007/s10995-011-0762-4


Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002–2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12–1.31); regular exercise (aRR 1.06, 95% CI 1.01–1.12), use of car safety devices (aRR 1.10, 95% CI 1.03–1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05–1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04–1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.


Child healthChild preventive healthHealth insuranceUsual source of careAccess to health careHealth care disparitiesHealth policyHealth care reform

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© Springer Science+Business Media, LLC 2011