Researchers find uninsured children most at risk for insufficient health care experiences

While medical home care may be improving primary care for children, these young patients may be disadvantaged by this team-based health care approach in other ways, according to a new study.

Researchers at the Keck School of Medicine of USC examined medical home trends in children’s primary care from 2003 to 2012 and found that while this specific health care model has improved children’s primary care overall, certain aspects of children’s patient care experience have worsened. Moreover, uninsured children were subject to more insufficient levels of care.

The study was published in the March issue of Maternal and Child Health Journal. “Overall, the medical home experience has improved over time for children across the nation, although some aspects have worsened,” said Gregory Stevens, PhD, associate professor of family medicine and preventive medicine at Keck School of Medicine and lead author of the study. “Children have better access to health care and a more continuous experience with their physicians. But children do not always have sufficient time with their physicians, and may not be receiving all the medical care that they need.”

The medical home is a team-based approach to health care that includes a personal physician who provides accessible, continuous, comprehensive and family-centered care to each patient.

To better analyze children’s medical home experiences, the team created several sociodemographic subgroups. In situations where children did not have positive medical home experiences, the team identified risk factors that may have contributed to poor outcomes, such as the level of education of the child’s parents, amount of insurance coverage and whether or not the child lived under the poverty line.

One subgroup seemed to fall behind even when other at-risk subgroups improved. Uninsured children had the lowest and most unstable medical home experiences over the past decade. The uninsured subgroup also had the children in most need of constant, quality care.

“We need to make extra efforts to ensure that all children have access to quality healthcare,” Stevens said. “Even if the Affordable Care Act is implemented exactly as planned, millions of people are expected to go without insurance, including children. We need to think of other ways to ensure that insurance is available for all children, or we need to expand other community resources.”

The resources to which Stevens refers include federally qualified community health centers (FQHC) and free clinics that cater to those who are not insured. Because the medical home model is a widely supported as a strategy for delivering high-quality primary care, FQHCs that operate using the medical home model have been entitled to additional federal funding.

by Mary Dacuma