RUNNING HEAD: CHILDREN’S HEALTHCARE

Children’s Healthcare: Disparities, Barriers, and Solutions

University of Maryland University College

E. Henderson, N. Llenas, E. Mock, A. Okeahialam

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Children’s Health

Access to care is a major issue facing America’s children today. These children who lack

access to care are more likely to not have a medical home, receive a lower quality of care, and

are more likely to die in infancy. Access to care can be defined as the “timely use of personal

health services to achieve the best possible health outcome” (Shim, 1999). Due to the enormity

of this problem the federal government provides healthcare for children through the Medicaid

system within each state. Even with these measures there are still millions of uninsured children

in American. Unfortunately reduced Medicaid payments have further exacerbated the problem.

Furthermore, studies have shown that minorities and the poor experience worse health outcomes

and lower quality of care than the U.S. population as a whole (King & Wheeler, 2007).

In 2006, there were an estimated 73.7 million children under 18 years of age in the

United States accounting for close to 25 percent of the population (HRSA, 2007). 13 million of

those children lived below the poverty level and 8.7 million had no health insurance coverage.

This astounding number reflects about 11 percent of the child population in the U.S. that does

not have any type of healthcare coverage. This problem was worsened by the increased poverty

rates in the U.S. Studies have shown that children born into poor families were the most likely to

be uninsured and have delayed medical care compared to children who were not poor. Thirteen

percent of children in families with an income less than $20,000 and17% of children in families

with an income of $20,000–$34,999 had no health insurance. This is compared to the 3% of

children in families with an income of $75,000 or more that were uninsured.

There is also some disparity in healthcare access. African American children were the

most likely to not be uninsured while white children were the most like to have private insurance

at about 77 percent leaving African American children at 50 percent covered and Hispanics at

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41%. However, African American children were the most like to have public coverage and

Hispanic children were most likely to have no coverage at all. Below is a chart depicting this

data.

Barriers to access

Parents often state that one of the main factors controlling their access to pediatric care is

the restrictive eligibility requirements set forth by Medicaid/SCHIP expansion or regular SCHIP

programs (DeVoe, 2007, p. 514). While requirement guidelines are outlined by the Federal

government, each state makes its own determination whether to extend or suppress enrollment.

Alabama, North Dakota, Oregon, Utah and Colorado are among the 10 most restrictive

states, allowing only incomes up to 133% of the Federal Poverty Level (FPL) for Medicaid

coverage ages 0 to 5 and 100% FPL for coverage of ages 6-19. The most liberal states are

Hawaii, District of Columbia, Maryland and Vermont; each covering children whose parent falls

under 300% FPL from ages 0 to 19. Regular SCHIP coverage often extends limits beyond the

Medicaid/SCHIP expansion program, as with New Jersey, who sets their limit at 350% FPL,

under their program (The Henry J. Kaiser Foundation, 2008).

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Family socioeconomics also have a role in preventing access to care for children.

According to the Census Bureau (2008), 34.5% of African-American children and 28.6% of

Hispanic children live below FPL, compared to 11.9% of Asian children and 10.1% of White

children. Consequently, these socioeconomic factors produce inequities in access. Seventy

percent of low-income (<200%FPL) children are uninsured (Kaiser Commission on Medicaid,

2008), and 32% of uninsured children have no usual source of care (Kaiser Commission on

Medicaid, 2008). There is also a broad correlation between poverty levels and socioeconomic

segregation as they relate to the health status and access to care for many impoverished children.

This segregation particularly plagues African-American and Hispanic children who are more

likely to live outside of the “opportunity neighborhoods” that serve middle class white children

and provide reasonable and quality care (Acevedo-Garcia, et al., 2008). Many families find the

ultimate barrier to access care for their children is cost. They find that after insurance is obtained

and access is granted, the final result is unaffordable deductibles, co-pays and prescriptions,

travel expenses, and lost wages (DeVoe et al., 2007).

Culturally and linguistically appropriate service mandates have been imposed upon all

facilities receiving Federal funds, to include hospitals, clinics and physician’s offices. The 2002

Medical Expenditures Panel Survey (MEPS), found that Hispanic children we the most likely to

lack a usual source of care. In a study utilizing the MEPS, Weinick & Krauss (2000) found that

among surveys not conducted in English, 40.7% were conducted in Spanish, and the participant’s

child was less likely to have a usual source of care compared to English speaking Hispanics, a

stance supported by Brotanek, et al. (2005), among others.

Other noted barriers relate directly to the nature of the healthcare system itself. A survey

by Sobo, Seid & Gelhard (2006), found that parents were becoming increasingly disoriented and

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discouraged by formalities of the U.S. healthcare system. Many barriers such as, documentation,

language skills and navigational skills, are internally defined by the system. Parents also express

disdain for the lack of customer service and time required to both obtain access and complete an

appointment. Finally, the doctors, themselves at times, become a part of the problem by not

treating the root causes identified. Physicians must be consistent with parents and patients,

communicate clearly and with compassion.

Issues facing healthcare workers

As noted, there are many reasons why children, especially minority children, do not

receive proper healthcare. Many times this directly affects the health care workers due to the

varied disparities that occur amongst each ethnic group. In previous studies the focuses of the

difficulty centers around Hispanic and African American youth.

One factor that stood out the most is the language barriers amongst not only the children

but also the parents. Parents play a major role in the many disparities of their children’s health

care. In one study by Flores, G. et al it states that racial and ethnic disparities, though have been

under grave review by the health care industry, is still a major factor as to why minority youth

receive poor health care. In the study it states that many Hispanic and African American children

have very poor health compared to Caucasian children who receive regular health care. Many of

the disparities are due to low income and not having proper health insurance to care for their

children. Single parent homes amongst the two ethnicities heavily contributed to a decrease in

healthcare visits.

The fact remains that health care workers have difficulty communicating with children

and parents whose primary language is not English. Difficulties persist in comprehending and

relaying the importance of following instructions, as well as, understanding the severity of

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certain diseases, mainly due to the lack of knowledge that correlates with socioeconomic status

and primary language. Many times non-English speaking minorities do not understand the

organization of the healthcare system or the resources that are available. Healthcare workers and

researchers believe it to be more helpful if interpreters are available to explain the importance of

disease management and how it can affect the health of their child. (Galbraith, Semura,,

McAninch-Dake,, Anderson & Christaki, 2008).

Additionally, non English-speaking minorities are unaware of the programs available to

insure their child and provide access to proper services. Shone, et al. (2003), describes the

availability of State Children’s Health Insurance Program in four states, Alabama, Florida,

Kansas, and New York. SCHIP was designed to address the many disparities among children,

especially that of racial and ethnic minorities, mainly that of Hispanic and African American

children. Unfortunately, the barrier still exists and continues to affect the health of children. In

the results of the study it points out that due to the lack of money, jobs, and proper education

both minority classifications had higher amounts of children that were uninsured. This was

contributed largely to the lack of health care insurance provided at their place of employment.

Furthermore, the percentages are much higher for Caucasian families than minorities. There were

also reports of less attention from health care workers for minority children and this causes

discouragement from minority families to return for follow up visits or even treat illnesses.

The disparities that healthcare workers face are more heavily weighed on the minorities

themselves. The question would be how to at least help more minority families to bring their

children in for appointments in the hopes of decreasing the disparities among young children.

Healthcare workers must lobby for proper interpretation services, educational programs for

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parents, cultural competence and increased community participation in the health of children and

the access they receive.

References

Brotanek, J. M., Halterman, J., Auinger, P., Weitzman, M. (2005). Inadequate access to care

among children with asthma from Spanish-speaking families. Journal of Health Care for

the Poor and Underserved. (16), 63-73. Retreived on November 9th, 2008 from

http://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/v01

6/16.1brotanek.pdf

Brown, E. (2005). Children’s usual source of care: United States, 2002. Medical Expenditure

Panel Survey: Agency for Healthcare Research and Quality. Retrieved on November 9th,

2008 from http://www.meps.ahrq.gov/mepsweb/data_files/publications/st78/stat78.pdf

DeNavas-Wait, C., Proctor, B. D., Smith, J. C. (2008). Health insurance coverage in the Unites

States: 2007. US Census Bureau. Retreived on November 9th, 2008 from

http://www.census.gov/prod/2008pubs/p60-235.pdf

DeVoe, J. E., Baez, A., Anglier, H., Krois, L., Edlund, C., & Carney, P.A. (2007). Insurance +

Access ≠Health care: Typology of barriers to health care access for low-income families.

Annals of Family Medicine (5)6, 511-518. Retreived on November 1, 2008 from

http://www.annfammed.org/cgi/reprint/5/6/511

Flores, G., Olson, L., Tomany-Korman, S.C. (2005, February) Racial and ethnic disparities in

early childhood health and health care. Pediatrics, 115(2), pp183-192. Retrieved October

16, 2008 from Academic Source Premiere

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Galbraith, A., Semura, J. I., McAninch-Dake, R.J., Anderson, N., Christaki, D.A. (2008).

Language disparities and timely care for children in managed care Medicaid. The

American Journal of Managed Care, 14(7), pp417-426. Retrieved October 16, 2008

from Academic Source Premiere.

HRSA. (2007). Child Health 2007. Retrieved November 12, 2008, from Health Resources and

Services Administrations: ftp://ftp.hrsa.gov/mchb/chusa_07/c07.pdf

King, T., & Wheeler, M. (2007). MEDICAL MANAGEMENT OF VULNERABLE AND

UNDERSERVED PATIENTS: PRINCIPLES, PRACTICE, AND POPULATIONS.

Journal of the American Medical Association , 297, 1133-1134.

Shim, B. (1999). Access to Care Issues for AmericaÕs Underserved. Retrieved November 15,

2008, from American Medical Student Association:

http://www.amsa.org/pdf/hlthcareunderserved.pdf

Shone, L.P., Dick, A.W., Brach, C., Kimminau, K.S., LaClair, B.J., Shenkman, E.A.,, et al.

(2003). The Role of race and ethnicity in the state children’s health insurance program

(SCHIP) in four states: Are there baseline disparities, and what do they mean for SCHIP?

Pediatrics, 112(6), pp521-532. Retrieved October 16, 2008 from Academic Source

Premiere.

The Henry J. Kaiser Family Foundation. (2008). Children’s access to care by health insurance

status, 2007. Retreived on November 9, 2008 from Kaiser Slides at

http://facts.kff.org/chart.aspx?ch=485

The Henry J. Kaiser Family Foundation. (2008). Uninsured children vs. all children by family

poverty level, 2007. Retreived on November 9, 2008 from Kaiser Slides at

http://facts.kff.org/chart.aspx?ch=751

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Weinick, R. M. & Krauss, N. A. (2000). Racial/ethnic differences in children’s access to care.

American Journal of Public Health. (90)11, 1771-1774. Retrieved on November 9th,

2008 from http://www.ajph.org/cgi/reprint/90/11/1771