Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling

Abstract

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child's receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002-2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12-1.31); regular exercise (aRR 1.06, 95% CI 1.01-1.12), use of car safety devices (aRR 1.10, 95% CI 1.03-1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05-1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04-1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.

Figure 1. Estimated Percentages* of US Children Reporting Never Receiving Preventive Health Counseling

*Estimated percentages are adjusted for child’s age, child’s race/ethnicity, parental employment, region of residence, parental education, household income, family composition, child’s health status, parent’s health insurance status, and parent’s usual source of care status. No Healthy Eating Counseling = Respondent reported having never received advice from a doctor or health care provider regarding child’s eating healthy (n=42,781, children aged 2-17). No Exercise Counseling = Respondent reported having never received advice from a doctor or health care provider regarding amount and kind of exercise, sports or physically active hobbies child should have (n=42,744, children aged 2-17). No Seat Belt Counseling = Respondent reported having never received advice from a doctor or health care provider about using a safety seat, booster seat, or lap and shoulder belts when child rides in the car (n=42,727, children aged 2-17). No Helmet Counseling = Respondent reported having never received advice from a doctor or health care provider about the child’s using a helmet when riding a bicycle or motorcycle (n=42,698, children aged 2-17). No Second Hand Smoke Counseling = Respondent reported having never received advice from a doctor or health care provider that smoking in the house can be bad for the child’s health (n=47,566, children aged 0-17). Note: Each multivariable model has a slightly different N, due to missing responses on outcomes and covariates.