title: A usual source of care: supplement or substitute for health insurance among low-income children?
abstract: OBJECTIVE
  To examine the separate and combined effects of having health insurance and a usual source of care (USC) on access to healthcare for low-income children and to determine if one or the other is superior in ensuring better access to necessary services.
  
  
  METHODS
  We conducted cross-sectional, multivariable analyses of data from a mail-return survey of Oregon's food stamp program. Results from 2681 completed surveys were weighted back to a population of 84,087 families with adjustments for oversampling techniques and nonresponse.
  
  
  RESULTS
  Among low-income Oregon children, those with health insurance and a USC reported the best access to healthcare. In multivariable comparisons to this reference group, insured children without a USC had higher rates of unmet medical need [odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.27-3.73]; no doctor visits in 12 months (OR = 6.77; 95% CI: 3.80-12.06); and problems obtaining specialty care (OR = 4.12; 95% CI: 1.59-10.68). Similarly, having a USC but not health insurance was associated with an even higher likelihood of unmet medical needs (OR = 4.33; 95% CI: 2.85-6.57); as well as unmet prescription needs (OR = 2.64, 95% CI: 1.77-3.94), and problems obtaining dental care (OR = 4.83; 95% CI: 3.31-7.06).
  
  
  CONCLUSIONS
  Incremental policy solutions are being proposed that focus on either health insurance coverage for children or expanded access to primary care. However, neither approach displaces the need for the other. The effects of a USC and health insurance, together, are additive predictors of the likelihood that children have optimal access to necessary healthcare services.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. devoej@ohsu.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.forename: Ryan
authors.initials: R
authors.lastname: Petering
authors.forename: Lisa
authors.initials: L
authors.lastname: Krois
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005522:Food Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009922:Oregon; D011203:Poverty; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data