Context Recent evidence suggests that children in working poor families lack
health resources, placing them at risk for inadequate access to care.
Objectives To examine financial and nonfinancial access and utilization of health
services among children in working poor families, and to compare these data
with those of children from both nonworking poor and moderate to affluent
families.
Design A cross-sectional study of 13 785 children younger than 18 years.
Participants Subjects from the 1997 National Health Interview Survey.
Main Outcome Measures Prevalence and continuity of health insurance coverage, of delayed or
missed care, and of unmet care needs; presence and type of usual source of
care; and the amount of visits to physicians, emergency departments, and hospitals.
Results Compared with children of nonworking poor parents and moderate to affluent
children, more working poor children were uninsured (22% vs 12% and 5%, respectively; P<.01) and experienced disruptions in insurance coverage
(P<.01). After adjusting for other covariates,
disparities in insurance coverage and continuity persisted, as did delays
in care and unmet care needs; these delays were far higher for the working
poor. Although these children had access to a regular source of care and had
utilization rates comparable with those of other poor children, they differed
markedly from moderate to affluent children on structural access and utilization
(adjusted odds ratios, 1.5-3.4).
Conclusions Children in working poor families experience far more barriers to care
than other children. Health insurance expansions through the Children's Health
Insurance Program and Medicaid, which reduce financial and nonfinancial barriers
to care, may help correct these disparities.
