Medical Home Disparities for Children by Insurance Type and State of Residence
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The objectives of this study are (1) to compare the prevalence of a medical home between children with public and private insurance across states, (2) to investigate the association between a medical home and state health care characteristics for children with public and private insurance. We performed a cross-sectional analysis of the 2007 National Survey of Children’s Health, estimating the prevalence of parents’ report of a medical home and its components for publicly- and privately-insured children in all 50 states and the District of Columbia. We then performed a series of random-effects multilevel logistic regression models to assess the associations between a medical home and insurance type, individual sociodemographic characteristics, and state level characteristics/policies. The prevalence of a medical home varied significantly across states for both publicly- and privately-insured children (ranges: 33–63 % and 57–76 %, respectively). Compared to privately-insured children, publicly-insured children had a lower prevalence of a medical home in all states (public–private difference: 5–34 %). Low prevalence of a medical home was driven primarily by less family-centered care. Variation across states and differences by insurance type were largely attributable to lower reports of a medical home among traditionally vulnerable groups of children, including racial/ethnic minorities and non-English primary language speakers. The prevalence of a medical home was not associated with state level characteristics/policies. There are significant disparities between states in parents’ report of a medical home for their children, especially for publicly-insured children. Interventions seeking to address these disparities will need to target family-centered care for traditionally vulnerable populations of children.
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- Medical Home Disparities for Children by Insurance Type and State of Residence
Maternal and Child Health Journal
Volume 16, Issue 1 Supplement, pp 178-187
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Medical home
- Public insurance
- Health policy
- National Survey of Children’s Health
- Industry Sectors
- Author Affiliations
- 1. Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, 300 NIB, Room 6C15, Ann Arbor, MI, 48109, USA
- 2. Department of Internal Medicine, Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA