Medical home disparities for children by insurance type and state of residence

Joseph S. Zickafoose*, Achamyeleh Gebremariam, Matthew M. Davis

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations

Abstract

The objectives of this study are (1) to compare the prevalence of a medical home between children with public and private insurance across states, (2) to investigate the association between a medical home and state health care characteristics for children with public and private insurance. We performed a cross-sectional analysis of the 2007 National Survey of Children's Health, estimating the prevalence of parents' report of a medical home and its components for publicly- and privately-insured children in all 50 states and the District of Columbia. We then performed a series of random-effects multilevel logistic regression models to assess the associations between a medical home and insurance type, individual sociodemographic characteristics, and state level characteristics/policies. The prevalence of a medical home varied significantly across states for both publicly- and privately-insured children (ranges: 33-63 % and 57-76 %, respectively). Compared to privately-insured children, publicly-insured children had a lower prevalence of a medical home in all states (public-private difference: 5-34 %). Low prevalence of a medical home was driven primarily by less familycentered care. Variation across states and differences by insurance type were largely attributable to lower reports of a medical home among traditionally vulnerable groups of children, including racial/ethnic minorities and non- English primary language speakers. The prevalence of a medical home was not associated with state level characteristics/ policies. There are significant disparities between states in parents' report of a medical home for their children, especially for publicly-insured children. Interventions seeking to address these disparities will need to target family-centered care for traditionally vulnerable populations of children.

Original languageEnglish (US)
Pages (from-to)178-187
Number of pages10
JournalMaternal and child health journal
Volume16
Issue numberSUPPL. 1
DOIs
StatePublished - Apr 2012

Keywords

  • Disparities
  • Health policy
  • Medical home
  • National Survey of Children's Health
  • Public insurance

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health

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