Research objective
•Annually, around 9 million injured children are treated in U.S. emergency departments.
• For injuries that require medical care beyond acute care facilities, effective follow-up care may reduce theprevalence of disabilities and lead to improved outcomes.
•Although uninsured children have been found to receive less preventive and routine services, little isknown about insurance-related disparities in obtaining recommended medical treatments followinginjuries especially using nationally representative samples.
•This study aims to examine the role of insurance status in receiving follow-up medical care after traumainjuries in children.
Health Insurance Status and Unmet Medical Needs Among Injured Children: A Population-Based Study
Faisal Alqahtani, MD,MPH1, Dinci Pennap, MPH2 and Suliman Alghnam, PhD1
Study design
•This is a retrospective study of the 1997-2006 Medical Expenditure Panel Survey (MEPS).
•Households, including children, from each panel are followed for approximately two years during whichthey are surveyed five times (every 4-5 months). In these surveys, parents report their children’s emerginghealth conditions and healthcare utilization.
• Children 0-17 years were included if they sustained an injury that was associated with at least onehospitalization, an emergency department visit, or an office-based visit.
•Once an injury is reported, parents are asked whether further treatment was recommended.
•If affirmed, a further question asks whether the child received all recommended care, received some of therecommended care, received no recommended care, or is still being treated for the condition.
•This response was used as the dependent variable with all recommended care as the reference categoryand insurance status (private as the reference, any public, or uninsured) as the independent variable.
• Multinomial regression model was used to model unmet healthcare needs in relation to insurance statusadjusting for potential confounders.
Conclusions
•Despite adjustment for demographics, baseline health and injury severity, uninsured children are morelikely to receive no follow-up care after injuries.
•Failure to obtain timely care may put those injured at a different trajectory for recovery and delay returnto pre-injury health.
Principal Findings
•Among injured children, 51 were uninsured, 359 were publicly insured and 577 had private insurance.
•Compared to privately insured and uninsured children, publicly insured children were significantly lesslikely to report excellent health at baseline.
•However, uninsured children were more likely to report higher perceived injury severity (p<0.01).
•Compared to privately insured children, uninsured children were more likely to receive no medical carefollowing injuries (odds ratio 4.6; 95% CI 1.0 – 20.6) adjusting for age, sex, race, baseline health andseverity.
•There were no differences in receiving follow-up care between publicly insured and privately insuredchildren.
Implications for Policy
•These results suggest health reform may be needed to increase access to health treatments among children withtraumatic injuries.
Affiliations: (1)Johns Hopkins University, School of Public Health, Baltimore, MD,
(2)University of Maryland, School of Pharmacy, Baltimore, MD