Study Says Health Insurance Alone May Not Reduce Racial Barriers to Health Care

May 04, 1999

Some Black and Hispanic may face continued barriers to care, even if they obtain health insurance under the State Children’s Health Insurance Program. That is the key finding of a University of Rochester research study which is being presented today at the 1999 Pediatric Academic Societies’ Annual Meeting in San Francisco.

The State Children’s Health Insurance Program, or SCHIP, was passed in 1997 as Title XXI of the Social Security Act. SCHIP provides $24 billion as block grants to states to insure poor children who do not qualify for Medicaid. Most states are just beginning to enroll children in SCHIP health insurance.

To predict the potential impact of the new SCHIP program, researchers at Children’s Hospital at Strong of the University of Rochester analyzed national data on 6,300 Hispanic, Black and White children ages 18 and under, using the 1996 Medical Expenditure Panel Survey. To determine childrens’ access to care, the researchers studied four commonly used measures including whether the child had a visit to a physician office or clinic in the past year, whether the child had a usual source of care (or "medical home"), and the availability of evening or weekend hours and the degree of difficulty in making an appointment.

"Having health insurance is an important first step in improving access, and the 105th Congress took a big step for children in creating the SCHIP program" said Laura Pollard Shone, MSW, principal investigator. "We wanted to see just how much of an impact this new program was likely to have, so we compared uninsured children to insured children with different types of insurance coverage – private, public, managed care, and traditional fee-fee-for-service. We found that, even through health insurance helps improve access to care, racial disparities persist, even among insured children, regardless of whether their insurance is private or public; managed care or not."

Controlling for other factors, Hispanic children were four times more likely than White children to lack a usual source of care, and Black children were five times more likely to than White children to lack a usual source of care. Hispanic and Black children were also more likely than White children to not have a visit to a physician office or clinic in the past year, to lack after-hours access, and to report difficulty making an appointment.

These findings are consistent with results of a prior study by Ms. Pollard Shone and her colleagues that measured racial disparities in access to care under New York State’s 8-year old Child Health Plus program. Although nearly all children had a "medical home" under Child Health Plus, Black, Hispanic and Asian children were still less likely to actually use specific services than their White counterparts. Child Health Plus was used as a model for SCHIP.

"It is tempting to think that once children are covered by health insurance that our job is done, but it is not," Pollard Shone said. "SCHIP is an important new program that will insure millions of previously uninsured children. However, our results strengthen existing evidence of racial disparities, and emphasize that the challenge of creating equal access to health care is much more complex than simply providing insurance coverage." "Identification of disparities does not necessarily tell us why they occur," Pollard Shone said, "But knowing where the problems are can help focus efforts now to evaluate and improve the SCHIP program, and ensure that all children have equal access to health care even after they are insured."

Other researchers in the study include Sheryl A. Ryan, M.D., Jonathan D. Klein, M.D., Peggy Auinger, and Peter G. Szilagyi, M.D. of the Strong Children’s Research Center at the University of Rochester.

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