Type of health insurance coverage and children's unmet health care needs: A mixed-methods approach

Background: Expansions in public health insurance programs for children and the inclusion of a public option in national insurance exchange programs have featured prominently in recent health insurance reform debates. We sought to examine—both qualitatively and quantitatively—whether low and middle income families reported differences between the effects of public and private coverage on children's access to healthcare. Methods: We conducted 24 face-to-face in-depth interviews throughout Oregon and used a standard iterative process with immersion/crystallization cycles for qualitative analysis. The qualitative findings guided a quantitative analysis of data from the nationally-representative Medical Expenditure Panel Survey, pooling years 2002-2006. We assessed univariate and multivariate associations between insurance type and unmet healthcare and preventive counseling needs among children in low income (n=28,338) and middle income (n=13,160) families. Results: All interviewees reported that health insurance was important to the health of their children. Respondents had mixed reviews of both private and public coverage with no clear consensus on one being a superior type of coverage. In quantitative analyses, there were no significant differences in parental reports of 15 unmet medical and preventive counseling needs when comparing children with public versus private coverage. In most cases, children with coverage gaps or no insurance were more likely to experience unmet needs, as compared with the reference group of privately-insured children. Conclusion: Type of coverage may not affect whether a child's basic healthcare needs are met, but children with partial or no health insurance tend to experience more unmet healthcare needs than their privately-insured counterparts.