Continuity of medical care, health insurance, and nonmedical advice in the first 3 years of life.

OBJECTIVES: The study seeks to evaluate whether continuity in medical care provides a mechanism that contributes to increased parental awareness of the importance of dental services, nutrition, and child development and whether health insurance encourages such continuity. METHODS: Data pertaining to medical utilization and dental, child nutrition, and child development counseling were extracted from the National Maternal and Infant Health Survey, 1988 and the 1991 Longitudinal Follow-up. These data permit the investigation of whether having continuity in medical care for a child increases the likelihood that the child's parent receives advice about dental health, nutrition, and child development. Restricting the analyses to Caucasian and African American women and excluding respondents with missing information on the child's health care utilization yielded 7056 participants. We created a set of binomial logit models, with correction for clustering (due to sample design). These models jointly estimate the likelihood that a child was classified as having continuity of care and the likelihood that the child's mother received advice about the 3 areas of interest. RESULTS: Private fee-for-service health insurance was found to increase the likelihood that a child receives continuity of care. When primary care was provided with high continuity of care, the probability that physicians provide mothers with dental, nutritional, and developmental advice was increased. CONCLUSIONS: These results suggest that continuity of care may have important spillover effects beyond direct medical care by improving maternal information about child dental care, nutrition, and developmental issues.

Duke Scholars

Author William Dalton Bradford Pathology