Trends in access to care for immigrant children in California: 2001 to 2003

Purpose: California's legislator have proposed major health reforms focusing firstly on insuring all children. Debate remains over how immigrants will be included in reforms. This study assesses the current status of and trends in health care access for children in immigrant families.

Methods: Cross-sectional data on 31,196 children from the 2001 and 2003 California Health Interview Survey were used to examine insurance coverage and access for four immigration groups: A) citizen, B) child citizen/legal resident, parent legal resident, C) child citizen/legal resident, parent undocumented, and D) undocumented.

Results: Reductions were found in the uninsured rate between 2001 and 2003 of 1.0% for group A (p<.001), 3.3% for B (p<.001), 8.5% for C (p<.05), and 11.9% for D (not significant). The proportion uninsured among undocumented children is much greater than citizens (D= 35.7% vs. A= 4.1%, p<.01). Children in groups B and D were less likely than A to have a regular source of care (OR=0.80, CI: 0.66-0.86 and OR=0.46, CI: 0.36-0.59), physician visit (OR=0.75, CI: 0.77-0.99 and OR=0.49, CI: 0.38-0.63), and dental visit (OR=0.87, CI: 0.77-0.99 and OR=0.36, CI: 0.28-0.46). The proportion of children with a regular source declined for both group A (93.5% to 89.6%, p<.001) and B (88.4% to 84.7%, p<.05). There was no decline in a regular source for group C or D.

Discussion: Children in immigrant families have experienced gains in health insurance coverage, but for a variety of possible reasons discussed, these gains have not translated into better access to care.