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.
KeywordsMedical home Public insurance Disparities Health policy National Survey of Children’s Health
American Academy of Pediatrics
Community health center
Children’s Health Insurance Program
Federal poverty level
Health maintenance organization
Intra-class correlation coefficient
National Survey of Children’s Health
We appreciate the generous advice of Tim Hofer, MD, MSc in the development and interpretation of the multilevel models in this paper. Dr. Zickafoose was supported by a training grant from the National Institute of Child Health and Human Development (T32 HD07534).
Conflict of interest
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