Children with public insurance are 22 percent less likely to receive comprehensive primary care than those with private insurance, according to research from the University of Michigan Medical School.
Public insurance programs cover one-third of children, many of whom belong to vulnerable groups, including minorities, the underprivileged and those in poor health. This includes children covered by Medicaid and the Children's Health Insurance Program (CHIP).
The study examined the instance of children with public health insurance who reported having a 'medical home,' a model for pediatric primary care endorsed by the American Academy of Pediatrics (AAP). The medical home approach is designed to facilitate partnerships between patients, parents and care providers. According to the AAP, a medical home is "accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective." It is often touted as a method of providing excellent pediatric primary care.
Only 45 percent of children with public insurance met all five of the components for a medical home (child's usual source of care, familiarity with a personal doctor/nurse, difficulty of obtaining referrals, access to family centered care and communication between care providers). This is far less than the 67 percent of children with private insurance who have a medical home.
The biggest differences between children with public and private insurance were found in family-centered care with significantly fewer parents of publicly insured children reporting that their child's provider spent enough time, listened carefully, displayed sensitivity towards family values and customs, and provided needed information.
However, more than 90 percent of children with public insurance reported having a usual source of medical care and a personal doctor. Given that this group has historically faced challenges in accessing and maintaining primary care, the researchers say this was very encouraging.
This study is the first to find such associations between a composite measure of the medical home and type of insurance in a broad cross-section of children. The findings provide a national benchmark for state programs promoting the medical home for publicly- and privately-insured children.
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