Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114150

Keith Elder, PhD, Dept of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC 29208, (803) 777 5041, kelder@gwm.sc.edu, Janice C. Probst, PhD, Health Administration, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, Daniel Patterson Patterson, PhD MPH, University of North Carolina at Chapel Hill Sheps Center for Health Services Research, 725 Airport Rd, Chapel Hill, NC 27599, and Charity G. Moore, PhD, MSPH, Department of Epidemiology and Biostatistics, University of South Carolina, Health Sciences Building, Sumter Street, University of South Carolina, Columbia, SC 29208.

RESEARCH OBJECTIVE: Over the past decade, Medicaid coverage for poor children has significantly expanded, principally through SCHIP. We examined the degree to which this expansion may have increased overall levels of insurance coverage for children, with a focus on rural and minority children (African American and Hispanic), across the period 1980-2000. We also assessed health care utilization patterns over time among rural children and whether the patterns were different for white and minority children.STUDY DESIGN: Data were drawn from the National Health Interview Survey, a nationally representative household survey conducted annually by the National Center for Health Statistics. Public use data sets for the years from 1980 through 2001 were accessed. The dependent variables were health insurance status, family poverty index, family structure (one or two parents in household), highest education level in the household, and doctor visits in past 12 months. All analyses were stratified by race (white, African American, Hispanic) and residence (urban, rural).POPULATION STUDIED: Children ages 0 –17. The number observed varied by survey year, from a high of 35,196 children in 1987 through 12,389 children in 1999. Rural was defined as residing outside an SMSA. PRINCIPAL FINDINGS: In 1979, the proportion of children who lacked health insurance ranged from 10.4% among urban whites to 36.3% among rural Hispanics. Among white children, the proportion without insurance peaked in 1994 at 20.9% (urban), declining to 5.9% in 2001. By 2001, only 8.7% of rural white children, 14.2% of rural African American children, and 26.7% of rural Hispanic children remained without coverage. Throughout the period, urban white children were least likely to be uninsured. Within each race/ethnicity, rural children were less likely to have insurance coverage than urban children, a disparity that remained unchanged across the period. The proportion of children with no physician visit in the preceding year declined over the period. Among urban whites, the proportion of children with no visit declined from 22.4% in 1979 to 9.4% in 2001. Among rural Hispanics, the most at-risk group, the proportion of children with no visit declined from 40.2% in 1979 to 24.4% in 2001. CONCLUSIONS: The proportion of children without insurance declined between 1979 and 2001, with parallel declines in the proportion of children with no access to health services. However, racial disparities remain, with rural minority children most likely to be uninsured and least likely to have seen a physician within the past year.

Learning Objectives:

• The participant will be able to identify national trends in uninsurance and health care utilization among rural minority children and make comparisons between rural whites and rural minority children from 1980-2001.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation