Maternal and Child Health Journal

, Volume 12, Issue 5, pp 670–678

Barriers to Children Having a Medical Home in Johnson County, Iowa: Notes from the Field

  • Hanes M. Swingle
  • Ralph Wilmoth
  • Mary L. Aquilino
Article

Abstract

Background In Iowa 70.7% of children who qualify for Title XIX and/or Title V services have a medical home, but in Johnson County, Iowa only 54.0% of such children have one. Objectives Identify barriers to access to a medical home for children who use Johnson County Public Health (JCPH) services and recommend strategies to overcome these barriers. Methods Families with children attending JCPH well-child and WIC clinics were randomly selected to be interviewed using a semi-structured, 38-item questionnaire. Data analysis used qualitative and quantitative methodologies. Results Among 71 families interviewed, 41 had children without a medical home and 85% of these families cited financial barriers. Lack of U.S. citizenship accounted for 59% without health insurance. A recent move contributed to 29% not having medical homes. Nine different languages were spoken among the 41 families without a medical home. Forty-one percent of all parents interviewed had never had a medical home themselves. Many parents perceived emergency departments as more convenient than doctors’ offices. Conclusions Lack of health insurance, due primarily to citizenship status, is the greatest barrier to access to a medical home in this population. The migratory nature of the U.S. population, marked cultural diversity, and parental attitudes were additional barriers to children’s access to a medical home. Strategies to overcome these barriers are discussed.

Keywords

Medical home Access Health insurance Medicaid 

Abbreviations

ED

Emergency department

JCPH

Johnson County Public Health

SCHIP

State Children’s Health Insurance Program

WIC

Women, infant, and children

References

  1. 1.
    American Academy of Pediatrics. (2002). The medical home. Pediatrics, 110(1 Pt 1), 184–186.Google Scholar
  2. 2.
    American Academy of Pediatrics. (1992). Ad hoc task force on definition of the medical home: The medical home. Pediatrics, 90(5), 774.Google Scholar
  3. 3.
    Gadomski, A., Jenkins, P., & Nichols, M. (1998). Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics, 101(3), E1.PubMedCrossRefGoogle Scholar
  4. 4.
    Hakim, R. B., & Bye, B. V. (2001). Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries. Pediatrics, 108(1), 90–97.PubMedCrossRefGoogle Scholar
  5. 5.
    Christakis, D. A., Mell, L., Koepsell, T. D., Zimmerman, F. J., & Connell, F. A. (2001). Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics, 107(3), 524–529.PubMedCrossRefGoogle Scholar
  6. 6.
    Kelleher, K. J., Childs, G. E., Wasserman, R. C., McInerny, T. K., Nutting, P. A., & Gardner, W. P. (1997). Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks. Archives Pediatrics & Adolescent Medicine, 151(11), 1109–1115.Google Scholar
  7. 7.
    Kempe, A., Beaty, B., Englund, B. P., Roark, R. J., Hester, N., Steiner, J. F. (2000). Quality of care and use of the medical home in a state-funded capitated primary care plan for low-income children. Pediatrics, 105(5), 1020–1028.PubMedCrossRefGoogle Scholar
  8. 8.
    Palfrey, J. S., Sofis, L. A., Davidson, E. J., Liu, J., Freeman, L., & Ganz, M. L. (2004). The pediatric alliance for coordinated care: Evaluation of a medical home model. Pediatrics, 113(5 Suppl), 1507–1516.PubMedGoogle Scholar
  9. 9.
    Newacheck, P. W., Stoddard, J. J., Hughes, D. C., & Pearl, M. (1998). Health insurance and access to primary care for children. The New England Journal of Medicine, 338(8), 513–519.PubMedCrossRefGoogle Scholar
  10. 10.
    Newacheck, P. W., Strickland, B., Shonkoff, J. P., Perrin, J. M., McPherson, M., McManus, M., et al. (1998). An epidemiologic profile of children with special health care needs. Pediatrics, 102(1 Pt 1), 117–123.PubMedCrossRefGoogle Scholar
  11. 11.
    Farmer, J. E., Clark, M. J., Sherman, A., Marien, W. E., & Selva, T. J. (2005). Comprehensive primary care for children with special health care needs in rural areas. Pediatrics, 116(3), 649–656.PubMedCrossRefGoogle Scholar
  12. 12.
    Iowa Department of Public Health. Medical Home Data by Age and County, provided by Johnson County Public Health, January 2006 (Unpublished data).Google Scholar
  13. 13.
    National Center for Health Statistics. National Survey of Children’s Health 2003. Available at: http://www.cdc.gov/nchs/about/major/slaits/nsch.htm. Accessed June 17, 2006.
  14. 14.
    Charles, B., Victor E., Soyer K. Policy Report. The Iowa Child Medicaid and Hawk-I programs and children’s developmental health: findings and recommendations for congressional action. Published by Child & Family Policy Center; October 2005.Google Scholar
  15. 15.
    The Kaiser Commission on Medicaid and the Uninsured. Health coverage for low-income children. Available at: http://www.kff.org/2144.cfm. Accessed February 23, 2007.
  16. 16.
    The Kaiser Commission on Medicaid and the Uninsured. Resuming the path to health coverage for children and parents: A 50-state update on eligibility rules, enrollment and renewal procedures, and cost sharing practices in Medicaid and SCHIP in 2006. Available at: http://www.kkf.org/medicaid/7608a.cfm. Accessed February 23, 2007.
  17. 17.
    Rau, J. (2007). Gov. seeks sweeping health system reforms. Los Angeles Times, January 8.Google Scholar
  18. 18.
    Shi, L., & Singh, D. A. (2004). Delivering health care in America. Sudbury, MA: Jones and Bartlett Publishers, Inc.Google Scholar
  19. 19.
    National Public Radio. Broadcast April 14, 2006.Google Scholar
  20. 20.
    U.S. Census Bureau. Available at: http://www.census.gov/. Accessed May 6, 2007.
  21. 21.
    Bohmer, R. (2007). The rise of in-store clinics—threat or opportunity? The New England Journal of Medicine, 356(8), 765–768.PubMedCrossRefGoogle Scholar
  22. 22.
    Glascoe, F. P. (2000). Early detection of developmental and behavioral problems. Pediatrics in Review, 21(8), 272–279; quiz 280.PubMedCrossRefGoogle Scholar
  23. 23.
    Atchison, C. (2005). Off to a good start: Framing policy for early childhood health systems integration, conference Sheraton Iowa City Hotel, Iowa City, IA, October 27 (Unpublished oral presentation).Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Hanes M. Swingle
    • 1
  • Ralph Wilmoth
    • 2
  • Mary L. Aquilino
    • 3
  1. 1.Department of PediatricsUniversity of South AlabamaMobileUSA
  2. 2.Johnson County Public HealthIowa CityUSA
  3. 3.College of Public HealthThe University of IowaIowa CityUSA

Personalised recommendations