Health insurance and access to care for families with young children in California, 2001-2005: differences by immigration status.
OBJECTIVE
To examine differences and trends in health insurance coverage and access to care for California families by immigration status.


METHODS
Cross-sectional data on 37,236 families with young children <18 years of age from the 2001, 2003 and 2005 California Health Interview Survey are used to assess trends in health insurance and access to care for children and their parents by four immigration dyads: (1) both are Citizens; (2) child is a legal resident/citizen, and parent is legal resident (Documented); (3) child is a citizen, and parent is undocumented (Mixed); and (4) both are Undocumented.


RESULTS
Before and after adjustment for covariates, only children in Undocumented dyads were less likely than Citizen dyads to have insurance (OR = 0.20, CI: 0.16-0.26) and all three measures of access: physician visits (OR = 0.69, CI: 0.52-0.91), dental visits (OR = 0.47, CI: 0.35-0.63), and a regular source of care (OR = 0.51, CI: 0.37-0.69). Parents in all non-Citizen dyads had poorer access than Citizen dyads across all measures, with the exception of dental visits and a regular source for parents in Documented dyads. Children of all dyads except Citizens were more likely to be insured in 2005 vs. 2001. The largest gain was for undocumented dyad children with 2.77 times higher odds (CI: 1.62-4.75) of being insured in 2005 vs. 2001. All children dyads except Mixed were also more likely to have a physician visit. For parents, there was only a decrease in insurance coverage for Citizen dyads (OR = 0.79, CI: 0.67-0.93) and few changes in access. Conclusions While there were relatively few disparities and some improvements in insurance coverage and access for children in California (except for undocumented children), concomitant changes for parents were not observed. Without attention to the family in health care reforms, disparities may not fully resolve for children and may continue or even increase for parents.
Stevens
Gregory D
GD
Department of Family Medicine, Center for Community Health Studies, University of Southern California Keck School of Medicine, 1000 South Fremont Avenue, Alhambra, CA 91803, USA. gstevens@usc.edu
West-Wright
Carmen N
CN
Tsai
Kai-Ya
KY
D000293:Adolescent; D000328:Adult; D002140:California; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003752:Dental Health Services / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005192:Family Health; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data*; D012923:Social Class; D055815:Young Adult
Med Care. 2002 Jan;40(1):52-9
11748426
Arch Pediatr Adolesc Med. 1998 Nov;152(11):1119-25
9811291
Am J Public Health. 2006 Apr;96(4):634-40
16507736
Med Care. 2007 Mar;45(3):206-13
17304077
Health Aff (Millwood). 2000 Jul-Aug;19(4):51-64
10916960
Pediatrics. 2004 Jan;113(1 Pt 1):101-7
14702456
Health Serv Res. 2006 Apr;41(2):486-506
16584461
Health Serv Res. 2006 Feb;41(1):125-47
16430604
Am J Public Health. 2003 Dec;93(12):2016-22
14652325
Public Health Rep. 2005 Jul-Aug;120(4):431-41
16025723
Am J Public Health. 2003 Oct;93(10):1630-3
14534212
J Immigr Health. 2001 Apr;3(2):59-75
16228790
Milbank Q. 2006;84(3):521-54
16953809
Health Aff (Millwood). 2001 Jan-Feb;20(1):247-56
11194848
Health Serv Res. 2004 Oct;39(5):1509-26
15333120
Health Soc Work. 1998 May;23(2):136-45
9598396
J Community Health. 2001 Apr;26(2):123-32
11322752
Pediatrics. 2006 Sep;118(3):e730-40
16950964
Pediatrics. 2008 Feb;121(2):e286-98
18195000
Health Aff (Millwood). 2001 Jan-Feb;20(1):257-66
11194849
Am J Public Health. 2005 Aug;95(8):1431-8
16043671
J Immigr Minor Health. 2008 Jun;10(3):247-54
18188701
Am J Epidemiol. 2001 Feb 15;153(4):372-80
11207155
J Immigr Health. 2004 Jan;6(1):5-13
14762320
Health Serv Res. 2003 Oct;38(5):1283-301
14596391
Med Care. 1985 Apr;23(4):350-60
3990390
Med Care Res Rev. 2003 Mar;60(1):3-30
12674018
Health Serv Res. 2004 Dec;39(6 Pt 1):1881-901
15533192
Matern Child Health J. 2005 Mar;9(1):27-34
15880972
Matern Child Health J. 1997 Jun;1(2):69-80
10728229
Am J Public Health. 2001 Nov;91(11):1806-7
11684608
Matern Child Health J. 2005 Dec;9(4):351-62
16292496
J Health Care Poor Underserved. 2002 Feb;13(1):12-23
11836910
Fam Med. 1998 Mar;30(3):196-205
9532442
Am J Public Health. 2006 Aug;96(8):1449-55
16809589
J Immigr Health. 2001 Jul;3(3):151-6
16228780