Children of Immigrants Health, Adjustment, and Public Assistance (1999) / Chapter Skim
Currently Skimming:
3 Access to Health Insurace and Health Care for Children in Immigrant Families
3 Access to Health Insurace and Health Care for Children in Immigrant Families
Pages 126-186
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 126... ...
Access to health care services, particularly for children, is important to en sure that acute and chronic conditions are diagnosed and treated in a timely manner, that health and development are adequately monitored, and that preventive services are provided as recom mended (American Academy of Pediatrics, 1995~. Without good access to primary medical care, acute conditions, such as middle ear infections or streptococcus infections, can lead to chronic, of ten disabling, conditions.
|
From page 127... ...
Although recent major changes in federal law will affect legal and undocumented immigrants' entitlement to health care services and other programs, few studies have examined immigrants' access to health insurance coverage and health care services (Thamer et al., 1997; Edmonston, 1996~. The research and theoretical literature on access to health care has focused considerable attention on disparities by ethnicity and race.
|
From page 128... ...
The extent to which immigrant children and U.S. citizen children in immigrant families have higher uninsured rates and/or less access to health care services has important policy and research implications.
|
From page 129... ...
The NHIS does not contain information on citizenship status, and it contains only limited information on national origin. Logistic regressions were used to examine the independent effects of immigration status, citizenship, and ethnicity on health insurance coverage and the effects of immigration status, ethnicity, and health insurance coverage on health care access.
|
From page 130... ...
citizen children in immigrant families were further classified by the year in which the parent who is the primary worker immigrated to the United States. Potential differences were examined among noncitizen children, citizen children in immigrant families, and children in nonimmigrant families in their access to public or private health in
|
From page 131... ...
Although legal immigrants, regardless of citizenship status, were entitled to Medicaid in 1995, we anticipated that noncitizen children may have less access to these benefits. The CPS does not distinguish between legal and undocumented immigrants; noncitizens as defined in this paper include both groups.
|
From page 132... ...
whose labor force participation provided the best opportunity for family members to receive health insurance coverage (we sometimes call this person the "primary worker" or "primary breadwinners. A family was classified as a "full-time, full-year employee family" if at least one of the parents reported working for an employer at least 35 hours per week for 50 to 52 weeks in 1995; a "full-time, part-year employee family" if a parent worked for an employer full time for less than 50 weeks; a "part-time employee family" if no parent worked as a full-time employee but one worked for an employer less than 35 hours a week; a "self-employed family" if a parent was self-employed; or a "nonworking family" if no parent worked during 1995.
|
From page 133... ...
Uninsurance, Ethnicity, and Immigration and Citizenship Status Noncitizen children and citizen children in immigrant families are more likely to lack health insurance coverage than children whose parents were born in the United States (see Figure 31~. This disparity in coverage rates by immigration and citizenship status varies by ethnicity.
|
From page 134... ...
White children have among the lowest uninsured rates, particularly low for white noncitizen children compared to noncitizen children in the other ethnic groups. For most children, health insurance coverage is obtained through their parents' employment.
|
From page 135... ...
These higher rates are associated with higher family incomes and, in the case of Asian immigrant families, larger proportions engaged in self-employment, which provides fewer opportunities for employment-based health insurance coverage. Uninsured rates among children vary by social and economic factors, in addition to the large differences by ethnicity and immigration and citizenship status.
|
From page 136... ...
136 to cn cn Cal CD Q .
|
From page 137... ...
137 o o o ~ o o o o CO ~CO ~ lo lo lo o CO lo lo lo Lr)
|
From page 138... ...
(12.4,18.2) (22.9,59 Family Income Below poverty 59 27 17 17 (52.1,66.2)
|
From page 139... ...
BROWN, WYN, YU, VALENZUELA, AND DONG 139 Asian (non-Latino) gild in Family Noncitizen Child Citizen Child in Immigrant Family Citizen Child in U.S.-Born Family 20 (1 8.1 ,23.0)
|
From page 140... ...
140 TABLE 3-2 Continuecl ACCESS TO HEALTH INSURANCE AND HEALTH CARE Latino (any race) Noncitizen Child Asian ant Citizen Child in Immigrant Family Citizen Child in U.S.-Born Family Noncitizen Family Work Status Full-time, full-year 55 31 15 22 employee (48.3,61.4)
|
From page 141... ...
BROWN, WYN, YU, VALENZUELA, AND DONG 141 Asian (non-Latino) gild in Citizen Child in Citizen Child in Family Noncitizen Child Immigrant Family U.S.-Born Family 22 11 5 (14.2,30.1 )
|
From page 142... ...
142 TABLE 3-2 Continuecl ACCESS TO HEALTH INSURANCE AND HEALTH CARE Latino (any race) Citizen Child in Citizen Child in Noncitizen Child Immigrant Family U.S.-Born Family Asian And Noncitizen State of Residence in the U.S.b California 51 28 14 15 (44.0,56.7)
|
From page 143... ...
BROWN, WYN, YU, VALENZUELA, AND DONG 143 Asian (non-Latino) gild in Family Citizen Child in Citizen Child in Noncitizen Child Immigrant Family U.S.-Born Family 15 (8.2,21 .0)
|
From page 144... ...
(13.2,16.2) (3 4,37 7 Family Income Below poverty 38 19 14 25 (17.3,59.6)
|
From page 145... ...
BROWN, WYN, YU, VALENZUELA, AND DONG 145 White (non-Latino) gild in Family Noncitizen Child Citizen Child in Immigrant Family Citizen Child in U.S.-Born Family 14 (8.2,1 9.9)
|
From page 146... ...
146 TABLE 3-2 Continuecl ACCESS TO HEALTH INSURANCE AND HEALTH CARE African American (non-Latino) White (n Citizen Child in Citizen Child in Noncitizen Child Immigrant Family U.S.-Born Family Noncitizen Family Work Status Full-time, full-year 39 9 14 12 employee (22.6,56.1 )
|
From page 147... ...
BROWN, WYN, YU, VALENZUELA, AND DONG 147 White (non-Latino) gild in ~ Family Noncitizen Child Citizen Child in Citizen Child in Immigrant Family U.S.-Born Family 12 (5.0,1 8.4)
|
From page 148... ...
148 TABLE 3-2 Continuecl ACCESS TO HEALTH INSURANCE AND HEALTH CARE African American (non-Latino) Citizen Child in Citizen Child in Noncitizen Child Immigrant Family U.S.-Born Family White Ant Noncitizen State of Residence in the U.S.
|
From page 149... ...
BROWN, WYN, YU, VALENZUELA, AND DONG 149 White (non-Latino) gild in ~ Family Citizen Child in Citizen Child in Noncitizen Child Immigrant Family U.S.-Born Family 19 (9.6,28.1 )
|
From page 150... ...
150 r - o oto rim l l o o o- o O O ~LO l - o oto l l l o o o- o O O CO N .m ~ Q)
|
From page 151... ...
Among Asian children with the defined characteristics, the probability of uninsurance is similarly greater among those who are citizens in immigrant families than among children with U.S.born parents, and it is greater still for noncitizen children. Citizen children with immigrant parents who arrived before 1984 have a lower probability of uninsurance than those who arrived more recently, but the relationship is reversed among noncitizen Asian
|
From page 152... ...
For black children the effect of immigration and citizenship status on uninsurance seems more complex. Citizen children with U.S.-born parents and those with immigrant parents all seem to cluster with probabilities of being uninsured ranging from 21 to 28 percent.
|
From page 153... ...
In each state Latino citizen children with immigrant parents have higher probabilities of being uninsured than do similar children in other ethnic groups. Many factors contribute to these differences among the states in the probability of being uninsured.
|
From page 155... ...
32 36 28 31 a Predicted probabilities for a female child, 3 to 5 years old, in good to excellent health, living in a two-parent family, with at least one parent employed full time for the full year, a family income of 100 to 199 percent of the federal poverty level, and one parent who is a primary worker and has not graduated from high school. SOURCE: March 1996 Current Population Survey.
|
From page 156... ...
New York and Florida have substantial non-Medicaid programs that provide health insurance to children, covering immigrant children who are not eligible for Medicaid as well as those who are eligible. In addition to differences in Medicaid eligibility and enrollment, states differ in other factors that may contribute to differences in uninsured rates.
|
From page 157... ...
Noncitizen children from Hong Kong, Japan, Singapore, Taiwan, Europe, China, the Philippines, Malaysia, and Indonesia all rank lower in their rates of uninsurance than those from Latin American countries; for most of the children in more advantaged families, their lower uninsurance rates reflect higher rates of employment-based health insurance, which typically accrues to workers with higher levels of educational attainment. Noncitizen children from Cambodia, Laos, and Vietnam rank lowest in uninsured rates (9 percent)
|
From page 158... ...
158 Q cn .
|
From page 159... ...
, and high rates of poverty (48 percent have family incomes below the poverty line)
|
From page 160... ...
Moreover, citizen children in immigrant families have a greater risk of being uninsured if their families immigrated to the United States in 1984 or later than if they immigrated earlier than 1984. Even after controlling for immigration and citizenship status, year in which parents immigrated, and important predictors of health insurance coverage, Korean- and Central American-origin children are more likely to be uninsured, for reasons that are not immediately clear.
|
From page 161... ...
EFFECTS OF IMMIGRATION STATUS ON ACCESS TO CARE Are children who are immigrants disadvantaged in their access to health care services compared to U.S.-born children in native-born families? Are U.S.-born children in immigrant families disadvantaged compared to those whose parents were born in the United States?
|
From page 162... ...
Information was obtained on whether or not the child has a usual person or place for medical care. Having a usual source of care has been demonstrated to be a robust measure of access to health care services.
|
From page 163... ...
Main Reasons for Lack of Coverage Among Children The main reason reported (by adult respondents) for children's lack of coverage is the same regardless of immigrant status: health insurance coverage is unaffordable (see Table 3-7~.
|
From page 164... ...
SOURCE: 1994 National Health Interview Survey.
|
From page 165... ...
BROWN, WYN, YU, VALENZUELA, AND DONG ;hilclren 165 Asian gild and Child U.S.-Born, Child and RentsImmigrant Immigrant Parents S BornChild Parents U.S.
|
From page 166... ...
(35,49) Immigrant children are less likely to have a usual source of care than nonimmigrant children regardless of their health insurance status whether uninsured, on Medicaid, or with private/ other coverage (data not shown)
|
From page 167... ...
Cost barriers were more important for children not born in the United States and U.S.-born children of immigrants than for nonimmigrant children. In contrast, the relocation of a previous physician was more important for nonimmigrant children.
|
From page 168... ...
It is, however, more common for nonimmigrant children to use private offices than it is for immigrant children and U.S.-born children with immigrant parents. For children, having access to a health care provider is critical for reasons beyond acute care needs.
|
From page 169... ...
22 (21, 23) Use of Health Care Services Immigrant children are less likely than either children of immigrants or children with U.S.-born parents to have had a doctor visit during the past year (see Table 3-8~.
|
From page 170... ...
TABLE 3-10 Type of Usual Source of Care by Immigration Status Among Chilclren with a Usual Source of Care, Ages O to 17, Unitecl States, 1994 Child of Nonimmigrant Child Immigrant Immigrant Child Parents Doctor's office/private clinic 63 County/public clinic 9 Community/migrant clinic 6 Health maintenance 10 organization/prepaid group Emergency room < 1 < Other 68 84 7 3 8 - 1 13 4 3 5 < 1 5 SOURCE: 1994 National Health Interview Survey.
|
From page 171... ...
. The comparative advantage of children with private/other coverage over uninsured children demonstrates the financial access that insurance coverage provides.
|
From page 172... ...
Among U.S.-born Asian children in immigrant families the ethnic group that is most disadvantaged in access TABLE 3-11 Preclictecl Probabilities of at Least One Physician Visit During Past Year Among U.S.-Born Chilclren with Immigrant Parents by Ethnicity, Ages 3 to 5, Unitecl States,1 994a Uninsured No Usual Source of Care (%) Medicaid Has Usual Source of Care (%)
|
From page 174... ...
To illustrate this relationship at the state level and to demonstrate the differences across states, we developed predicted probabilities of at least one physician visit for a U.S.-born child with at least one immigrant parent with the specified characteristics: Latino, female, 3 to 5 years old, good to excellent health and no activity limitations, family of four, family income between 100 and 199 percent of poverty, and mother who did not graduate from high school. Within each of these six states, children were less likely to have received at least one physician visit if they were uninsured and lacked a usual source of care (see Figure 3-5~.
|
From page 175... ...
175 o o o o o o o of ~Cal 7 X ~ I ~ ~ =0 .Q O ~ tt 5Z V)
|
From page 176... ...
DISCUSSION AND POLICY IMPLICATIONS Being a noncitizen or having immigrant parents puts a child at greater risk of being uninsured than are citizen children in native-born families. This risk is substantial even controlling for parents' education and the duration of parents' residence in the United States, as well as core determinants of uninsurance.
|
From page 177... ...
It is noteworthy that Latino children, regardless of their own or their family's immigration and citizenship status, are at greater risk of uninsurance, even controlling for educational attainment, family work status, and family income. We should underscore the findings of this study that, even when immigrant parents work full time for the full year as employees, their children are more likely to be uninsured than are children in nonimmigrant families and for some groups these increased risks are substantial.
|
From page 178... ...
Having a usual source of care and health insurance coverage greatly reduces the disadvantage, but Asian children remain less likely to have had the recommended number of physician visits even after accounting for these factors. Thus, even controlling for educational attainment and duration of residence in the United States, as well as for age, gender, family work status, and family income, substantial disparities in uninsurance remain between noncitizen immigrant children and citizen children with native-born parents.
|
From page 179... ...
The effects of these policies may be at least partially offset by the State Children's Health Insurance Program, created by the federal Balanced Budget Act of 1997, if states make noncitizen children eligible for these programs. Uninsured lowincome immigrant children and nonimmigrant children in immigrant families may experience further reductions in their access to health care services if funds are reduced for community health centers and other programs that finance services for low-income persons.
|
From page 180... ...
Board on Children and Families 1995 Immigrant children and their families: Issues for research and policy. The Future of Children: Critical Issuesfor Children and Youth 5~2~:72-89.
|
From page 181... ...
Wang 1993 Health Insurance Coverage of California's Latino Population and Their Use of Health Services. Berkeley: California Policy Seminar, University of California.
|
From page 182... ...
Health Insurance Status Outcome Variable The child's health insurance coverage was the outcome variable in this portion of the study. The March CPS asks respondents about health insurance coverage for each family member during the previous calendar year.
|
From page 183... ...
In 1995, the year reflected in the CPS questions on health insurance coverage, the poverty level was set at $15,569 for a family of four. Family Structure We categorized a child as living in a two-parent or a singleparent family.
|
From page 184... ...
Variables Used in Analysis of Reasons for Uninsurance, Health Care Access, and Use of Health Care Services We used data from the 1994 National Health Interview Survey (NHIS) to study reasons for uninsurance among uninsured children, whether a child has a usual source of care, and a child's use of health care services.
|
From page 185... ...
Having a usual source of care has been demonstrated to be a robust measure of access to health care services. We therefore used usual source of care as an outcome variable but also as a predictor of use of phy .
|
From page 186... ...
The first asks respondents which of a series of statements describes why their child is not covered by any health insurance coverage. The second question asks what the main reason is for lack of coverage.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.