title: Medical home disparities for children by insurance type and state of residence.
abstract: The objectives of this study are (1) to compare the prevalence of a medical home between children with public and private insurance across states, (2) to investigate the association between a medical home and state health care characteristics for children with public and private insurance. We performed a cross-sectional analysis of the 2007 National Survey of Children's Health, estimating the prevalence of parents' report of a medical home and its components for publicly- and privately-insured children in all 50 states and the District of Columbia. We then performed a series of random-effects multilevel logistic regression models to assess the associations between a medical home and insurance type, individual sociodemographic characteristics, and state level characteristics/policies. The prevalence of a medical home varied significantly across states for both publicly- and privately-insured children (ranges: 33-63 % and 57-76 %, respectively). Compared to privately-insured children, publicly-insured children had a lower prevalence of a medical home in all states (public-private difference: 5-34 %). Low prevalence of a medical home was driven primarily by less family-centered care. Variation across states and differences by insurance type were largely attributable to lower reports of a medical home among traditionally vulnerable groups of children, including racial/ethnic minorities and non-English primary language speakers. The prevalence of a medical home was not associated with state level characteristics/policies. There are significant disparities between states in parents' report of a medical home for their children, especially for publicly-insured children. Interventions seeking to address these disparities will need to target family-centered care for traditionally vulnerable populations of children.
authors.affiliation: Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, 300 NIB, Ann Arbor, MI 48109, USA. josephzi@med.umich.edu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Zickafoose
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence; D017149:Private Sector / Q000191:economics / Q000706:statistics & numerical data*; D011632:Public Assistance; D017150:Public Sector / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013221:State Health Plans; D014481:United States