Increasing Access to Care for Low-Income Children at the County-Level

Using the 2007 California Health Interview Survey, we used multivariate logistic regressions to assess the impact of county-level policy factors on access to care among low-income children. We analyzed data for 3,984 children under age 19 in the sample who met our criteria of having one the following insurance statuses for the past 12 months: 1) was continuously insured with either Medi-Cal or Healthy Families programs (California's Medicaid and CHIP programs, or MC/HF), 2) had MC/HF coverage and became uninsured, 3) was uninsured and gained MC/HF coverage, and 4) was uninsured all year. We then studied the association of county-level policy factors and our three access to care outcome measures (having a usual source of care, visiting a doctor the age-appropriate number of times in the past year, and any delay in needed care), controlling for individual-level factors. While other county-level factors had no significant association, whether or not a county used the electronic One E-App system to enroll children in their programs was associated with increased self-reporting of having a current usual source of care (OR=1.5, p=0.0193). This finding highlights the importance of investments in technology to improve access to health care for low-income children. The program is providing a direct benefit to MC and HF enrollees, increasing their access to a usual source of care.