The ecology of medical care for children in the United States.
BACKGROUND
Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children.


OBJECTIVE
To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings.


METHODS
Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care).


RESULTS
Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13-17 years) and poverty status were associated with hospitalization (P <.05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals.


CONCLUSIONS
The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.
Robert Graham Center, Policy Studies in Family Practice and Primary Care, American Academy of Family Physicians, Washington, DC 20036, USA. sdovey@aafp.org
Susan
S
Dovey
Michael
M
Weitzman
George
G
Fryer
Larry
L
Green
Barbara
B
Yawn
David
D
Lanier
Robert
R
Phillips
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D004463:Ecology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D019037:Urban Health Services / Q000191:economics / Q000706:statistics & numerical data