Effects of insurance status on children's access to specialty care: a systematic review of the literature.

Published online

Journal Article (Review)

BACKGROUND: The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral. Our objective was to review the literature on the effects of insurance status on children's access to specialty care. METHODS: We conducted a systematic review of original research published between January 1, 1992 and July 31, 2006. Searches were performed using Pubmed. RESULTS: Of 30 articles identified, the majority use number of specialty visits or referrals to measure access. Uninsured children have poorer access to specialty care than insured children. Children with public coverage have better access to specialty care than uninsured children, but poorer access compared to privately insured children. Findings on the effects of managed care are mixed. CONCLUSION: Insurance coverage is clearly an important factor in children's access to specialty care. However, we cannot determine the structure of insurance that leads to the best use of appropriate, quality care by children. Research about specific characteristics of health plans and effects on health outcomes is needed to determine a structure of insurance coverage that provides optimal access to specialty care for children.

Full Text

Duke Authors

Cited Authors

  • Skinner, AC; Mayer, ML

Published Date

  • November 28, 2007

Published In

Volume / Issue

  • 7 /

Start / End Page

  • 194 -

PubMed ID

  • 18045482

Pubmed Central ID

  • 18045482

Electronic International Standard Serial Number (EISSN)

  • 1472-6963

Digital Object Identifier (DOI)

  • 10.1186/1472-6963-7-194

Language

  • eng

Conference Location

  • England