226176 Healthcare cost "trade-offs" with basic needs: Impact on maternal and child health in five cities

Monday, November 8, 2010 : 11:10 AM - 11:30 AM

Karen Jeng, AB , Data Coordinating Center, Boston University School of Public Health, Boston, MA
Stephanie Ettinger de Cuba, MPH , Data Coordinating Center, Boston University School of Public Health, Boston, MA
Sharon M. Coleman, MS, MPH , Data Coordinating Center, Boston University School of Public Health, Boston, MA
Alan F. Meyers, MD, MPH , Department of Pediatrics, Boston Medical Center, Boston, MA
Ruth Rose-Jacobs, ScD , Department of Pediatrics, Boston Medical Center, Boston, MA
Deborah A. Frank, MD , Department of Pediatrics, Boston Medical Center, Boston, MA
Patrick Casey, MD , Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
Diana B. Cutts, MD , Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN
Mariana Chilton, PhD, MPH , Health Management and Policy, Drexel University School of Public Health, Philadelphia, PA
Maureen Black, PhD , Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore, MD
John T. Cook, PhD , Department of Pediatrics, Boston University School of Medicine, Boston, MA
Background: Associations between household healthcare costs and child and maternal health are unknown, even when children are insured. State public assistance policies, including health insurance, may influence households' ability to balance healthcare expenditures and basic needs. Design/Methods: Children's HealthWatch (2007-2009) interviewed 6447 mothers from low-income households with children age 0-36 months at 5 pediatric clinic/emergency departments (Baltimore, Boston, Little Rock, Minneapolis, Philadelphia). Mothers were asked about trade-offs (paid medical/prescription costs versus rent, utilities, food), household demographics, maternal and child health status, child developmental risk (determined by Parents' Evaluation of Developmental Status), and health insurance status. Multivariate logistic regression stratified by city examined adjusted associations between trade-offs, maternal health, and child health and development. Results: 2.8%, 5.6%, 9.9%, 3.7%, and 4.8% of mothers in Baltimore, Boston, Little Rock, Minneapolis, and Philadelphia, respectively, reported trade-offs. Compared to families with no trade-offs, mothers in “trade-off families” in all five cities had higher odds of fair/poor health: Baltimore (AOR 2.33 [1.02, 5.32, p=0.046]), Boston (AOR 2.05 [1.23, 3.42, p=0.01]) Little Rock (AOR 2.76 [1.82, 4.18, p<0.001]), Minneapolis (AOR 2.67 [1.53, 4.67, p<0.001]), Philadelphia (AOR 3.89 [1.96, 7.73, p<0.001]). Significant associations between trade-offs and child health and developmental risk were also found. Further adjusted analyses will be presented to describe city differences and contributing factors. Conclusions: “Trade-offs” with healthcare costs correlate with mothers' poorer health and often with increased risk to child health and development. Public policies (decreasing out-of-pocket expenses for healthcare and increasing basic needs assistance) may enhance well-being of mothers and children.

Learning Areas:
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the impact on maternal and child health and child developmental risk associated with families’ need to trade-off payment of household expenses, such as rent, utilities or food, versus medical care or prescriptions. Discuss possible public policy interventions that would decrease the need for trade-offs to enhance the health and well-being of mothers and children.

Keywords: Maternal and Child Health, Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I participate in research that monitors the impact of economic conditions and public policies on maternal and child health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.