Predictors of delayed or forgone needed health care for families with children

Abstract

Background: We sought to determine how health care-related financial burden, childhood activity limitations, health insurance, and other access-related factors predict delayed or forgone care for families with children, using a nationally representative, population-based sample.

Methods: Our sample included families with children aged 0 to 17 years whose family was interviewed about their health care expenditures in 1 of 7 panels of the 2001 to 2008 Medial Expenditure Panel Survey (N = 14 138). Financial burden was defined as (1) the sum of out-of-pocket health service expenditures during the first survey year and (2) that sum divided by adjusted family income. Delayed or forgone care was defined as self-report of delayed or forgone medical care or prescription medications for the reference parent or child during the second survey year.

Results: Financial burden, discordant insurance, and having a child with an activity limitation were some of the strongest predictors of delayed or forgone care. Additionally, significant health insurance and income-related disparities exist in the experience of delayed or forgone care.

Conclusions: Children and their families are delaying or forgoing needed care due to health care-related financial burden. Policies are needed to effectively reduce financial burden and improve the concordance of insurance between parents and children because this may reduce the frequency of unmet need among families. Moreover, reducing the occurrence of delayed or forgone care may improve health outcomes by increasing the opportunity to receive timely and preventive care.

FIGURE 1

Predicted probability of delayed or forgone care by financial burden and activity limitation status: the relationship between financial burden and the predicted probability of delayed or forgone care due to cost or insurance-related reasons. The models in Tables 3 and 4 were used to calculate the average predicted probability of experiencing delayed or forgone care due to cost or insurance-related reasons (y-axis) as a function of financial burden (x-axis) while controlling for all other covariates included in the final models. A, This relationship with absolute financial burden. B, This relationship with relative financial burden. In both panels, the solid top line (black) represents the predicted probabilities for families of a child with an ongoing activity limitation, the dashed middle line (black) represents the predicted probabilities for families of a child with a resolved activity limitation and the solid bottom line (gray) represents the predicted probabilities for families of children without any activity limitations. The vertical dotted line corresponds to the mean value of financial burden. The 95th percentile of the financial burden measure was used as the x-axis maximum in both panels. The table included to the right of each graph displays the values of financial burden for families of children with and without activity limitations that correspond to the predicted probability of delayed or forgone care due to cost or insurance, by increments of 0.01. Source: 2001–2008 MEPS.