title: Children's health insurance status, access to and utilization of health services, and unmet health needs in a rural Alabama school system.
abstract: OBJECTIVE
  This study examines the relationship between children's health insurance status and utilization of health services, establishment of a medical home, and unmet health needs over a 3-year period (1996-1998) in a rural Alabama K-12 school system.
  
  
  METHODS
  As part of a children's health insurance outreach program, questionnaires were administered to parents of 754 children regarding health and health care access. In addition, noninvasive head-to-toe physical assessments of children were conducted on-site at 4 schools.
  
  
  RESULTS
  A relationship between health care utilization and insurance status was observed. Results found that insured children had 1.183 (P < .0115) times the number of medical visits as uninsured children. Among uninsured children, the time since last dental visit was 1.6 (P < .001) times longer than that of insured children. Also, insured children were 5.21 times more likely than uninsured (P < .0001) to report having a medical home. No significant differences between insured and uninsured children were found regarding unmet health needs as measured by referrals made after the children's physical assessments.
  
  
  CONCLUSIONS
  Child health coverage is an important determining factor in the ability of families to access and utilize health care services. These findings have implications for populations in similar rural communities across the nation.
authors.affiliation: tcarter@ches.ua.edu
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Carter
authors.forename: Marsha Howell
authors.initials: MH
authors.lastname: Adams
authors.forename: Alesa Hicks
authors.initials: AH
authors.lastname: Judd
authors.forename: James D
authors.initials: JD
authors.lastname: Leeper
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000407:Alabama; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D016017:Odds Ratio; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012574:Schools / Q000706:statistics & numerical data