Determinants of Health Care Use by Children in Rural Western North Carolina: Results From the Mountain Accessibility Project Survey

• Published in: Pediatrics (Evanston) 2003-08, Vol.112 (2), p.e143-e152
• Main Authors: Woods, Charles R, Arcury, Thomas A, Powers, James M, Preisser, John S, Gesler, Wilbert M
• Format: Article
• Language: English
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.112.2.e143

Objective. To assess determinants of health care visits among children in a 12-county region of western North Carolina representative of rural areas in the United States. Methods. Households were randomly selected for surveys of household characteristics, health status, and health care use. Surveys were conducted June 1999 to January 2000 and were stratified for children younger than 5 years and 5 years and older. The number of health care visits in the year before the survey was used as the outcome measure. Weighted mean visits and associations of family demographic and child health variables with the number of visits were determined by ratio and multivariate survey regression methods. Results. Among children who lived in rural Appalachian regions of North Carolina in 1999, 90% had either public or private insurance coverage. The mean number of visits per child was 5.7 (median: 2.6), and in each age group the number of visits in the previous year exceeded the recommended number of well-child visits. There were no apparent geographic access barriers to care in this population, in that increased distances to provider sites did not result in declining numbers of visits. For children younger than 5 years, the primary determinants of health care use during the previous year were age, insurance status, and household income. Infants had more visits than older, preschool children, and those with household incomes >$40 000 per year had 76% more visits than those with incomes $40 000 per year were associated with 2.5-fold increased health care visits, and those with household incomes between $20 000 and $40 000 per year had 2-fold increased health care visits, compared with those with household incomes