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Journal of Family and Economic Issues

, Volume 36, Issue 1, pp 154–164 | Cite as

Health Care Use Among Rural, Low-Income Women and Children: Results from a 2-Stage Negative Binomial Model

  • Swetha ValluriEmail author
  • Sheila Mammen
  • Daniel Lass
Original Paper

Abstract

Determinants of healthcare use among rural, low-income mothers and children were assessed using a 2-stage negative binomial model of joint mother/child choices and data from a multi-state, longitudinal study, Rural Families Speak. Maternal healthcare use increased with higher depression scores, chronic conditions, new medical conditions, number of children, pediatric visits, prenatal/post-partum needs, and health insurance coverage. Maternal visits decreased with lower income, age, child’s chronic conditions, and child’s private health insurance. Pediatric visits increased with new medical conditions, greater number of chronic conditions, and maternal health visits. Pediatric visits decreased with maternal depression, pregnancy, Latina and African American mothers, more children, and private health insurance coverage. The 2-stage model shows mothers simultaneously choose healthcare visits for themselves and their child.

Keywords

Rural health care Pediatric health care utilization Maternal health care utilization Behavioral Model of Health Services Utilization 

Notes

Acknowledgments

This research was supported in part by USDA/CSREES/NRICGP Grant Numbers 2001-35401-10215 & 2002-35401-11591, 2004-35401-14938. Data were collected in conjunction with the cooperative multi-state research project, NC-223/NC-1011, “Rural Low–Income Families: Monitoring Their Well-being and Functioning in the Context of Welfare Reform.” Cooperating states are California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, and Oregon.The authors gratefully acknowledge the assistance of Megan Gay, undergraduate research assistant, University of Massachusetts Amherst.

References

  1. Akresh, I. R. (2009). Health service utilization among immigrants to the United States. Population Research Policy Review, 28(6), 795–815. doi: 10.1007/s11113-009-9129-6.CrossRefGoogle Scholar
  2. Al-Windi, A., Dag, E., & Kurt, S. (2002). The influence of perceived well-being and reported symptoms on health care utilization: A population-based study. Journal of Clinical Epidemiology, 55(1), 60–66. doi: 10.1016/s0895-4356(01)00413-1.CrossRefGoogle Scholar
  3. Andersen, R. (1968). A Behavioral Model of Families Use of Health Services. Chicago, IL: University of Chicago Center for Health Administrative Services Research Series website. http://www.ssa.uchicago.edu/sites/default/files/uploads/RS25.PDF. Accessed Aug 2013.
  4. Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. doi: 10.2307/2137284.CrossRefGoogle Scholar
  5. Andersen, R. (2008). National health surveys and the behavioral model of health services. Medical Care, 46(7), 647–653. doi: 10.1097/MLR.0b013e31817a835d.CrossRefGoogle Scholar
  6. Andersen, R., & Aday, L. A. (1978). Access to medical care in the U.S.: Realized and potential. Medical Care, 16(7), 533–546. doi: 10.1097/00005650-197807000-00001.CrossRefGoogle Scholar
  7. Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Millbank Memorial Fund Quarterly: Health and Society, 51(1), 95–124. doi: 10.1111/j.1468-0009.2005.00428.x.CrossRefGoogle Scholar
  8. Arcury, T. A., Gesler, W. M., Preisser, J. S., Sherman, J., Spencer, J., & Perin, J. (2005a). The effects of geography and spatial behavior on health care utilization among the residents of a rural region. Health Services Research, 40(1), 135–156. doi: 10.1111/j.1475-6773.2005.00346.x.CrossRefGoogle Scholar
  9. Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005b). Access to transportation and health care utilization in a rural region. The Journal Rural Health, 21(1), 31–38. doi: 10.1111/j.1748-0361.2005.t600059.x.CrossRefGoogle Scholar
  10. Babitsch, B., Gohl, D., & von Lengerke, T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: A systematic review of studies from 1998 to 2011. GMS Psycho-Social-Medicine, 9. doi: 10.3205/psm000089.
  11. Brandt, S., & St. Marie, P. (2011). Racial disparities in hospital length of stay for asthma: Implications for economic policies. Journal of Family and Economic Issues, 32(1), 152–169. doi: 10.1007/s10834-010-9201-8.CrossRefGoogle Scholar
  12. Cairney, J., & Wade, T. J. (2002). Single parent mothers and mental health care service use. Social Psychiatry and Psychiatric Epidemiology, 37(5), 236–242. doi: 10.1007/s00127-002-0539-6.CrossRefGoogle Scholar
  13. Casey, M. M., Thiede Call, K., & Klingner, J. M. (2001). Are rural residents less likely to obtain recommended preventive healthcare services? American Journal of Preventive Medicine, 21(3), 182–188. doi: 10.1016/s0749-3797(01)00349-x.CrossRefGoogle Scholar
  14. Coburn, A. F., McBride, T. D., & Ziller, E. C. (2002). Patterns of health insurance coverage among rural and urban children. Medical Care Research and Review, 59(3), 272–292. doi: 10.1177/1077558702059003003.CrossRefGoogle Scholar
  15. DeVoe, J. E., Baez, A., Angier, H., Krois, L., Edlund, C., & Carney, P. A. (2007). Insurance+ access≠ health care: Typology of barriers to health care access for low-income families. The Annals of Family Medicine, 5(6), 511–518. doi: 10.1370/afm.748.CrossRefGoogle Scholar
  16. Dubay, L., & Kenney, G. M. (2001). Health care access and use among low-income children: Who fares best? Health Affairs, 20(1), 112–121. doi: 10.1377/hlthaff.20.1.112.CrossRefGoogle Scholar
  17. Erdwins, C. J., Buffardi, L. C., Casper, W. J., & O’Brien, A. S. (2001). The relationship of women’s role strain to social support, role satisfaction, and self-efficacy. Family Relations, 50(3), 230–238. doi: 10.1111/j.1741-3729.2001.00230.x.CrossRefGoogle Scholar
  18. Finkelstein, A., Taubman, S., Wright, B., Bernstein, M., Gruber, J., Newhouse, J. P., et al. (2011). The Oregon Health Insurance Experiment: Evidence from the First Year. The Quarterly Journal of Economics, 127(3), 1057–1106. doi: 10.1093/qje/qjs020.CrossRefGoogle Scholar
  19. Flores, G., Olson, L., & Tomany-Korman, S. C. (2005). Racial and ethnic disparities in early childhood health and health care. Pediatrics, 115(2), 183–193. doi: 10.1542/ped.2004-1474.CrossRefGoogle Scholar
  20. Gamm, L., Stone, S., & Pittman, S. (2010). Mental health and mental disorders—A rural challenge: A literature review. Rural Healthy People, 2, 97–113. Rural healthy people 2010: A companion document to healthy people 2010 website. http://srph.tamhsc.edu/centers/rhp2010/Volume2.pdf. Accessed Aug 2013.
  21. Halfon, N., Inkelas, M., & Wood, D. (1995). Nonfinancial barriers to care for children and youth. Annual Review of Public Health, 16(1), 447–472. doi: 10.1146/annurev.pu.16050195.002311.CrossRefGoogle Scholar
  22. Hemard, J. B., Monroe, P. A., Atkinson, E. S., & Blalock, L. B. (1999). Rural women’s satisfaction and stress as family health care gatekeepers. Women and Health, 28(2), 55–77. doi: 10.1300/J013v28n02_04.CrossRefGoogle Scholar
  23. Hilbe, J. M. (2011). Negative Binomial Regression (2nd ed.). New York, NY: Cambridge University Press.CrossRefGoogle Scholar
  24. Janicke, D. M., & Finney, J. W. (2000). Determinants of children’s primary health care use. Journal of Clinical Psychology in Medical Settings, 7(1), 29–39. doi: 10.1023/A:1009593202834.CrossRefGoogle Scholar
  25. Janicke, D. M., Finney, J. W., & Riley, A. W. (2001). Children’s health care use: A prospective investigation of factors related to care-seeking. Medical Care, 39(9), 990–1001.CrossRefGoogle Scholar
  26. Kahn, R. S., Wise, P. H., Finkelstein, J. A., Bernstein, H. H., Lowe, J. A., & Homer, C. J. (1999). The scope of unmet maternal health needs in pediatric settings. Pediatrics, 103(3), 576–581. doi: 10.1542/peds.103.3.576.CrossRefGoogle Scholar
  27. Kaiser Family Foundation. (2011). Medicaid matters: Understanding Medicaid’s role in our health care system. The Kaiser commission on Medicaid and the uninsured. Retrieved from the Henry J. Kaiser Family Foundation website: http://kff.org/health-reform/fact-sheet/medicaid-matters-understanding-medicaids-role-in-our/. Accessed Aug 2013.
  28. Kasper, J. D., Giovannini, T. A., & Hoffman, C. (2000). Gaining and losing health insurance: Strengthening the evidence for effects on access to care and health outcomes. Medical Care Research and Review, 57(3), 298–318. doi: 10.1177/10.7755870005700302.CrossRefGoogle Scholar
  29. King, J., Holmes, G. M., & Slifkin, R. T. (2010). Rural and urban differences in children’s medicaid and CHIP participation. Inquiry, 47(2), 150–161. doi: 10.5034/inquiryjrnl_47.02.150.Google Scholar
  30. Kouzis, A. (2005). Social factors, need, and mental health services utilization: Findings of the national comorbidity survey. Research in the Sociology of Health Care, 23, 57–78. doi: 10.1016/S0275-4959(05)23004-1.CrossRefGoogle Scholar
  31. Laditka, J. N., Laditka, S. B., & Probst, J. C. (2009). Health care access in rural areas: Evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health & Place, 15(3), 761–770. doi: 10.1016/j.healthplace.2008.12.2007.CrossRefGoogle Scholar
  32. Lenardson, J. D., Ziller, E. C., Coburn, A. F., & Loux, S. L. (2009). Health insurance coverage in rural America: Chartbook. Retrieved from the University of Southern Maine, Muskie School of Policy Service, Institute of Health Policy website: http://muskie.usm.maine.edu/Publications/rural/Rural-Health-Insurance-Chartbook-2009.pdf. Accessed Aug 2013.
  33. Mayberry, R. M., Mili, F., & Ofili, E. (2000). Racial and ethnic differences in access to medical care. Medical Care Research and Review, 57(4 suppl), 108–145. doi: 10.1177/107755800773743628.CrossRefGoogle Scholar
  34. Menclova, A. K. (2013). The effects of unemployment on prenatal care use and infant health. Journal of Family and Economic Issues, 34(4), 400–420. doi: 10.1007/s10834-012-9339-7.CrossRefGoogle Scholar
  35. Miller, G. E., & Pylypchuk, Y. (2013). Marital status, spousal characteristics, and the use of preventive care. Journal of Family and Economic Issues,. doi: 10.1007/s10834-013-9375-y.Google Scholar
  36. Minkovitz, C. S., O’Campo, P. J., Chen, Y. H., & Grason, H. A. (2002). Associations between maternal and child health status and patterns of medical care use. Ambulatory Pediatrics, 2(2), 85–92. doi: 10.1367/1539-4409(2002)002<0085:AMBACH>2.0.C0;2.CrossRefGoogle Scholar
  37. Mokkink, L. B., Van der Lee, J. H., Grootenhuis, M. A., Offringa, M., & Heymans, H. S. (2008). Defining chronic diseases and health conditions in childhood (0–18 years of age): National consensus in the Netherlands. European Journal of Pediatrics, 167(12), 1441–1447. doi: 10.1007/s00431-008-0697-4.CrossRefGoogle Scholar
  38. Newacheck, P. W., & Taylor, W. R. (1992). Childhood chronic illness: Prevalence, severity, and impact. American Journal of Public Health, 82(3), 364–371. doi: 10.2105/AJPH.82.3.364.CrossRefGoogle Scholar
  39. Olfson, M., Marcus, S. C., Druss, B., Pincus, H. A., & Weissman, M. M. (2003). Parental depression, child mental health problems, and health care utilization. Medical Care, 41(6), 716–721. doi: 10.1097/00005650-200306000-00004.Google Scholar
  40. Perrin, E. C., Newacheck, P., Pless, I. B., Drotar, D., Gortmaker, S. L., Leventhal, J., et al. (1993). Issues involved in the definition and classification of chronic health conditions. Pediatrics, 91(4), 787–793.Google Scholar
  41. Porterfield, S. L., & McBride, T. D. (2007). The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs. Journal Information, 97(2). doi: 10.2105/AJPH.2004.055921.
  42. Riley, A. W., Finney, J. W., Mellits, E. D., Starfield, B., Kidwell, S., Quaskey, S., et al. (1993). Determinants of children’s health care use: An investigation of psychosocial factors. Medical Care, 31(9), 767–783. doi: 10.1097/00005650-199309000-00002.CrossRefGoogle Scholar
  43. Shen, Y. C., & McFeeters, J. (2006). Out-of-pocket health spending between low-and higher-income populations: Who is at risk of having high expenses and high burdens? Medical Care, 44(3), 200–209. doi: 10.1097/ol.mlr.0000199692.78295.7c.CrossRefGoogle Scholar
  44. Shi, L., & Stevens, G. (2005). Vulnerability and unmet health care needs. The influence of multiple risk factors. Journal of General Internal Medicine, 20(2), 148–154. doi: 10.1111/j.1525-1497.2005.40136.x.CrossRefGoogle Scholar
  45. Sibley, L. M., & Weiner, J. P. (2011). An evaluation of access to health care services along the rural–urban continuum in Canada. BMC Health Services Research, 11(1), 20. doi: 10.1186/1472-6963-11-20.CrossRefGoogle Scholar
  46. Simmons, L. A., Anderson, E. A., & Braun, B. (2008). Health needs and health care utilization among rural, low-income women. Women and Health, 47(4), 53–69. doi: 10.1080/03630240802100317.CrossRefGoogle Scholar
  47. Slifkin, R. (2002). Developing policies responsive to barriers to health care among rural residents: What do we need to know? The Journal of Rural Health, 18(5), 233–241. doi: 10.1111/j.1748-0361.2002.tb.00933.x.CrossRefGoogle Scholar
  48. Sobo, E. J., Seid, M., & Gelhard, L. R. (2006). Parent-identified barriers to pediatric health care: A process-oriented model. Health Services Research, 41(1), 148–172. doi: 10.1016/s0033-3506(01)00449-8.CrossRefGoogle Scholar
  49. Sturm, R., & Wells, K. B. (2001). Does obesity contribute as much to morbidity as poverty or smoking? Public Health, 115(3), 229–235. doi: 10.1038/sj.ph.1900764.CrossRefGoogle Scholar
  50. Waldorf, B. (2007). Measuring rurality. Retrieved from the Kelley School of Business, Indiana Business Research Center website: http://www.incontext.indiana.edu/2007/january/2.asp. Accessed Aug 2013.
  51. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629. doi: 10.1001/archpsyc.62.6.629.CrossRefGoogle Scholar
  52. Weinick, R. M., Zuvekas, S. H., & Cohen, J. W. (2000). Racial and ethnic differences in access to and use of health care services, 1977–1996. Medical Care Research and Review, 57(suppl 1), 36–54. doi: 10.1177/1077558700574003.CrossRefGoogle Scholar
  53. Weissman, J. S., Stern, R., Fielding, S. L., & Epstein, A. M. (1991). Delayed access to health care: Risk factors, reasons, and consequences. Annals of Internal Medicine, 114(4), 325–331. doi: 10.7326/0003-4819-114-4-325.CrossRefGoogle Scholar
  54. Witt, P. W., Litzelman, K., Mandic, G. C., Wisk, L. E., Hampton, J. M., Creswell, P. D., et al. (2011). Healthcare-related financial burden among families in the US: The role of childhood activity limitations and income. Journal of Family and Economic Issues, 34(2), 308–326. doi: 10.1007/s10834-011-9253-4.
  55. Woods, C. R., Arcury, T. A., Powers, J. M., Preisser, J. S., & Gesler, W. M. (2003). Determinants of health care use by children in rural western North Carolina: Results from the mountain accessibility project. Pediatrics, 112(2), 143–152. doi: 10.1542/peds.112.2.e143.CrossRefGoogle Scholar
  56. Wooldridge, J. M. (2002). Econometric analysis of cross section and panel data. The MIT press, Cambridge.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of BiostatisticsGeorge Washington UniversityWashingtonUSA
  2. 2.Department of Resource EconomicsUniversity of Massachusetts AmherstAmherstUSA
  3. 3.Department of Resource EconomicsUniversity of Massachusetts AmherstAmherstUSA

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