Maternal and Child Health Journal

, Volume 15, Issue 8, pp 1238-1248

First online:

Comparing Type of Health Insurance Among Low-Income Children: A Mixed-Methods Study from Oregon

  • Jennifer E. DeVoeAffiliated withDepartment of Family Medicine, Oregon Health and Science University Email author 
  • , Lorraine WallaceAffiliated withDepartment of Family Medicine, University of Tennessee Graduate School of Medicine
  • , Shelley SelphAffiliated withDepartment of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University
  • , Nicholas WestfallAffiliated withSchool of Medicine, Oregon Health and Science University
  • , Stephanie CrockerAffiliated withSchool of Medicine, Oregon Health and Science University

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We employed a mixed-methods study of primary data from a statewide household survey and in-person interviews with parents to examine—quantitatively and qualitatively—whether low-income children experienced differences between public and private insurance coverage types. We carried out 24 in-depth interviews with a subsample of respondents to Oregon’s 2005 Children’s Access to Healthcare Study (CAHS), analyzed using a standard iterative process and immersion/crystallization cycles. Qualitative findings guided quantitative analyses of CAHS data that assessed associations between insurance type and parental-reported unmet children’s health care needs. Interviewees uniformly reported that stable health insurance was important, but there was no consensus regarding which type was superior. Quantitatively, there were only a few significant differences. Cross-sectionally, compared with private coverage, public coverage was associated with higher odds of unmet specialty care needs (odds ratio [OR] 3.54; 95% confidence interval [CI] 1.52–8.24). Comparing full-year coverage patterns, those with public coverage had lower odds of unmet prescription needs (OR 0.60, 95% CI 0.36–0.99) and unmet mental health counseling needs (OR 0.24, 95% CI 0.10–0.63), compared with privately covered children. Low-income Oregon parents reported few differences in their child’s experience with private versus public coverage.


Child health insurance Child access to care Medicaid CHIP Health services research Health policy Health care disparities