title: Attenuation of racial differences in health service utilization patterns for previously uninsured children in the Delta.
abstract: BACKGROUND
  A school-based health insurance program for children of the working poor was conducted in 2 isolated, rural communities in the Lower Mississippi Delta region. The larger of the 2 communities had an array of locally available health care providers, whereas the smaller community did not. In response to this lack of available care, the project designed and delivered outreach programs, including transportation to providers.
  
  
  OBJECTIVE
  The purpose of this paper is to examine the role of race, age, and gender in the relationships between the utilization of care and the impact of outreach programs.
  
  
  METHODS
  General estimating equation models are used to examine the response of utilization variables to race, age, gender, and community. Four years of insurance claims data are analyzed.
  
  
  RESULTS
  Race is seen to be an important component of utilization. The majority of participants were African American; however, children receiving prescription services, emergency room care, routine physician visits, and hospital outpatient services were more likely to be white. Outreach programs in vision and dental services were found to eliminate racial differences and increase utilization. A relatively strong gender effect was found in prescription, wellness, vision, and dental services.
  
  
  CONCLUSIONS
  Previous research has shown differences by race in utilization of care. Our findings show that targeted outreach programs can significantly diminish these differences. Findings also suggest that barriers to health care for poor rural children are closely linked to transportation and availability of providers, not merely to cost of care or insurance.
authors.affiliation: School of Human Environmental Sciences, University of Arkansas-Fayetteville, Fayetteville, AR 72701, USA.
authors.forename: Zola K
authors.initials: ZK
authors.lastname: Moon
authors.forename: Frank L
authors.initials: FL
authors.lastname: Farmer
authors.forename: John M
authors.initials: JM
authors.lastname: Tilford
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000191:economics / Q000208:ethnology; D003159:Community-Institutional Relations; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008507:Medically Underserved Area; D017057:Medically Uninsured / Q000208:ethnology*; D008913:Minority Groups / Q000706:statistics & numerical data*; D008922:Mississippi / Q000453:epidemiology; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data