title: Comparing types of health insurance for children: a public option versus a private option.
abstract: BACKGROUND
  Many states have expanded public health insurance programs for children, and further expansions were proposed in recent national reform initiatives; yet the expansion of public insurance plans and the inclusion of a public option in state insurance exchange programs sparked controversies and raised new questions with regard to the quality and adequacy of various insurance types.
  
  
  OBJECTIVE
  We aimed to examine the comparative effectiveness of public versus private coverage on parental-reported children's access to health care in low-income and middle-income families. METHODS/PARTICIPANTS/MEASURES: We conducted secondary data analyses of the nationally representative Medical Expenditure Panel Survey, pooling years 2002 to 2006. We assessed univariate and multivariate associations between child's full-year insurance type and parental-reported unmet health care and preventive counseling needs among children in low-income (n=28,338) and middle-income families (n=13,160).
  
  
  RESULTS
  Among children in families earning <200% of the federal poverty level, those with public insurance were significantly less likely to have no usual source of care compared with privately insured children (adjusted relative risk, 0.79; 95% confidence interval, 0.63-0.99). This was the only significant difference in 50 logistic regression models comparing unmet health care and preventive counseling needs among low-income and middle-income children with public versus private coverage.
  
  
  CONCLUSIONS
  The striking similarities in reported rates of unmet needs among children with public versus private coverage in both low-income and middle-income groups suggest that a public children's insurance option may be equivalent to a private option in guaranteeing access to necessary health care services for all children.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239, USA. devoej@ohsu.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Tillotson
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
authors.forename: Shelley
authors.initials: S
authors.lastname: Selph
authors.forename: Alan
authors.initials: A
authors.lastname: Graham
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage; D016015:Logistic Models; D015999:Multivariate Analysis; D009310:National Health Insurance, United States; D017149:Private Sector; D011787:Quality of Health Care; D012306:Risk; D012959:Socioeconomic Factors; D014481:United States