Family structure, socioeconomic status, and access to health care for children

• Published in: Health services research 2002-02, Vol.37 (1), p.173-186
• Main Authors: Heck, Katherine E, Parker, Jennifer D
• Format: Article
• Language: English
• Subjects: Adolescent; Care and treatment; Child; Child Health Services - economics; Child Health Services - utilization; Child, Preschool; Children; Children & youth; Family Characteristics; Health care access; Health care industry; Health Care Surveys; Health insurance; Health Services Accessibility - economics; Health Services Accessibility - statistics & numerical data; Health Services Research - methods; Health services utilization; Humans; Infant; Insurance Coverage; Longitudinal Studies; Medicaid; Medical care; Office Visits - utilization; Parents & parenting; Single Parent; Social Class; Socioeconomic factors; Statistical analysis; United States
• ISSN: 0017-9124; 1475-6773

To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families. The National Health Interview Surveys of 1993-95, including 63,054 children. Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES. Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage. At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mo