Access to health care and child health in the United States

The United States reproduces health disparities along socioeconomic lines including household income, mother's education, and race or ethnic group, and keeps losing ground in its international health rankings. The U.S. Department of Health and Human Services (HHS) suggests there is a role for health care access and related policies and interventions, for eliminating health disparities and improving population health. HHS uses a Determinants of Health model to illustrate supposed effects of health care on population health.;To investigate effects of access to health care on U.S. child health, this study examined U.S. child health data from a nationally representative set of cross-sectional child health data, the 2007 National Survey of Children's Health (Child and Adolescent Health Measurement Initiative). The sample contains reports of an adult caregiver for n = 91,642 children from the 50 states and the District of Columbia. Respondents were selected by computer-assisted random-digit dialing. Interviewers conducted computer-assisted surveys with more than 200 questions about child demographics, health, functioning, and access to health care.;This study uses six contextual variables: special health care need, child's age, child's sex, child's race or ethnic group, household income compared to the federal poverty level, and mother's level of education. This study includes care variables and insurance variables in testing for access to health care models that are predictive of child health outcomes. The care variables are unmet need, no personal doctor or nurse, no usual place for care, and no preventive care visit. The insurance variables are insurance less than year-round insurance for the full data set, and insurance that does not always allow needed providers and does not always have reasonable shared cost for the subset with children insured at the survey (n = 73,118).;The study's eight hypotheses are that controlling for contextual characteristics, children without access to health care are less likely to be categorized as having excellent or very good health status, more likely to be categorized as having limited ability to do things most children of the same age can do, less likely to engage in vigorous physical activity for at least 20 minutes in a week, less likely to participate in an organized activity outside school, more likely to miss school because of illness or injury, more likely to repeat a grade, more likely to be underweight, and more likely to be overweight or obese, than children with access to health care.;This study used hierarchical binary logistic regression to provide effects of nested models of contextual variables and predictor variables on child health outcomes. Analyses produced odds ratios of the access to health care variables for two discrete outcome categories, poorer health and better health, for each of the study outcomes.;Multivariate analyses indicated statistically significant models of access to health care for seven of the study's eight hypotheses; there was not adequate model fit of the data for low body mass index. As suggested by the U.S. Department of Health and Human Services (2000), there are models of access to health care that predict child health, which has immediate and long term implications for population health.;Further study is needed to examine between-state comparisons using the national data set, and to examine linkages than are not provided by the secondary data including studies of insurance adequacy, whether corner drug store providers play a role in child health, and implications of access to health care for education.