Uninsured or Not, Children Have Similar Behavioral Problems

September 28, 2000

Children who do not have health insurance are just as likely to be diagnosed with a behavioral problem as those with coverage, and pediatricians treat them much the same regardless of insurance status, say physicians at Children's Hospital at Strong.

The findings are published in this week's Journal of the Ambulatory Pediatric Association. The study is a companion to one published in the June issue of Pediatrics that found the number of children with behavioral problems nearly tripled during the last 20 years.

Nearly 14 percent of U.S. children are uninsured. Previous studies indicate they are more likely than insured children to lack access to health care and to have worse reported health status, but, until now, little was known about mental and behavioral health care for uninsured children.

Physicians used data from the national Child Behavior Study - collected by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network Physicians - to compare the prevalence of behavioral problems and mental health services received by insured and uninsured children in primary care practice. Children who are covered by Medicaid were considered insured in this study.

Thomas McInerny, M.D., lead author and associate chair of clinical affairs at Children's Hospital at Strong, says physicians discovered little difference.

Of the 13,401 visits made to pediatricians who had three or more uninsured patients, 12,518 (93.4 percent) were by insured children and 883 (6.6 percent) were by uninsured children. A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured.

Physicians taking part in the study reported that insured and uninsured children had similar rates of behavioral problems (19 percent each) and severe psychosocial problems (2 percent each). Researchers earlier surmised that uninsured children might have a higher rate of such problems, but no data was available to prove or disprove it.

For children with a physician-identified behavioral problem, researchers found no differences in physician-reported counseling, medication use, or referral to mental health professionals.

"Physicians tend to be insurance blind," McInerny says. "Once the child comes through the door, they are usually treated the same whether they are insured or not."

Like every study, McInerny acknowledges this one has some limitations. For example, the demographics of the population studied are not representative of U.S. children as a whole. In addition, the study neither attempted to measure in detail the quality of care nor the appropriateness of management by providers.

Still, McInerny is confident of the results.

"This study is the largest of its type to examine the incidence of behavioral problems in children presenting to pediatricians and family physicians who provide the vast majority of primary care for children," McInerny says. "One can reasonably extrapolate the results to those children seen in similar settings."

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