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Sabrina T. Wong, RN, PhD; Alison Galbraith, MD, MPH; Sue Kim, PhD, MPH; Paul W. Newacheck, DrPH

Arch Pediatr Adolesc Med. 2005;159:1008-1013.

Objective  To examine whether income-related disparities in the burden of children’s out-of-pocket health care expenditures have diminished with the expansions in public insurance for children in low-income families.

Design  We compared absolute financial burden (out-of-pocket expenditures per child) and relative financial burden (out-of-pocket expenditures per child as a proportion of family income) among children aged 0 to 18 years in 6 poverty level groups using the 1980 National Medical Care Utilization and Expenditure Survey and the 2000 Medical Expenditure Panel Survey. Regression models were used to assess whether disparities in financial burden diminished between 1980 and 2000.

Results  There were significant reductions (P<.01) in absolute burden over time for children above 200% of the federal poverty level. Relative financial burden decreased significantly (P<.01) for all of the income groups, ranging from a reduction of 36.49% for those below 100% of the federal poverty level (95% CI, –49.54% to –20.07%) to a reduction of 46.69% for those at or above 300% of the federal poverty level (95% CI, –54.43% to –37.62%). For low-income children, relative financial burden was 49.49% less with public insurance (95% CI, –66.24% to –24.35%) and 79.14% greater with private insurance (95% CI, 9.31% to 193.59%) than relative financial burden for low-income children without insurance.

Conclusions  While the financial burden of children’s out-of-pocket health care expenditures has decreased for all of the income groups over time, socioeconomic disparities persist. However, public insurance coverage appears to mitigate the financial burden for low-income children.

Author Affiliations: School of Nursing, University of British Columbia, Vancouver, British Columbia (Dr Wong); Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Mass (Dr Galbraith); and Medical Effectiveness Research Center for Diverse Populations (Dr Kim) and Institute for Health Policy Studies (Dr Newacheck), University of California, San Francisco.

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