Disparities in Children's health care quality: Findings from the 2006 National Healthcare Disparities Report

Research Objective: To examine racial and ethnic disparities in health care quality of children by comparing differences in health insurance coverage. Study Design: Data come from the 2006 National Healthcare Disparities Report, which compiled national estimates on 211 measures of health care quality from 3 dozen data sources. Selected measures for this study include preventive care measures and patient centeredness measures for children. Analyses focus on 14 measures from the full measure set and comparisons of Non-Hispanic Whites, blacks and Hispanics based on available nationally representative data for children. For race/ethnicity comparisons, blacks and Hispanics are compared to Non-Hispanic Whites. Race/ethnicity data were further stratified by insurance status for children with private insurance, public insurance, and no insurance. Only differences that were statistically significant are presented. Principal Findings: Health insurance coverage was a significant factor in differences in preventive care services for children. Uninsured children had the worst quality of care for preventive care compared to children with health insurance. Uninsured children were less likely to receive hepatitis vaccine, have vision check, and receive advice about physical activity and healthy eating than those with health insurance. There are significant racial and ethnic disparities in children's preventive care. Hispanics had poorer quality of care compared to whites for 6 out of 14 measures. Blacks had poorer quality of care compared to whites for 5 out of 14 measures. Children with insurance did not always get better care. There were race and ethnic disparities among children with private insurance for 8 out of 14 measures. For children with public insurance, 7 out of 14 measures showed race and ethnic disparities for blacks and Hispanics. Children with public insurance were the least likely to have patient centered care and timely appointments for care. Conclusions: Children's health care quality varies by insurance status and type of health insurance. There are significant racial and ethnic disparities overall and within insurance populations. Children with no health insurance experience worse care than children with health insurance. However, children with public insurance experience poorer patient centered care than children with no insurance. Implications for Policy, Delivery, or Practice: The findings point to important opportunities missed to provide preventive care services for children despite health insurance coverage. Hispanic children and black children experience worse care for most measures than white children even when they have health insurance.