Access to health care for children and adolescents in working poor families: recent findings from California.
BACKGROUND
Children in working poor families are among the most disadvantaged, yet little is known about barriers to care for these children.


OBJECTIVE
We sought to compare health care access and use by children from working poor families with other poor and nonpoor children and consider the extent to which expansions in public health insurance have contributed to increased access in California.


METHODS
This was cross-sectional study using data from the 2001 California Health Interview Survey, a representative telephone survey. Using this survey, we were able to include 16,528 children younger than the age of 18 in our analysis. We measured financial and nonfinancial access to health care and service use.


RESULTS
Children in working poor families had higher odds of being uninsured (adjusted odds ratio 2.9, 95% confidence interval 2.0, 4.1; adjusted odds ratio 3.7, 95% confidence interval 2.9, 4.8, respectively) compared with children in nonworking poor/TANF and nonpoor families. Disparities in nonfinancial access and use between the working poor and nonworking poor narrowed considerably when controlling for insurance and other covariates. Compared with nonpoor children, disparities in access were wider. The largest disparities in use were in dental care. After controlling for insurance and other covariates, disparities remained.


CONCLUSIONS
Despite public insurance expansions, particularly through Healthy Families, disparities in insurance coverage between the working poor and other poor and nonpoor children remain, placing children of the working poor at a disadvantage for access and use. Insurance coverage expansions must be protected and coupled with continued efforts to narrow nonfinancial barriers to care.
Guendelman
Sylvia
S
Division of Health Policy & Management, School of Public Health, University of California, Berkeley, California 94720-7360, USA. sylviag@uclink.berkeley.edu
Angulo
Veronica
V
Oman
Doug
D
D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D011203:Poverty; D012959:Socioeconomic Factors