Nevertheless, most of the studies we analyzed used many different measures of access and found that insured children were more likely to have access to both preventive and acute or chronic health care. Having a primary care connection made it easier for children to get regular preventive care, acute care when ill, and more complex care as needed. Uninsured and lower-income children were more likely to be hospitalized for conditions that could have been treated through primary care. Health Insurance Increases Children’s Access to Preventive and Primary Care

Most of the studies we reviewed showed that children who had health insurance had better access to preventive and primary health care than uninsured children. Using regression analysis to isolate the effect of insurance from race, income, and ethnicity, this study found that uninsured children were twice as likely to lack a usual source of care as insured children. Uninsured children were also more likely to lack after-hours care and to spend more time traveling and more time waiting to receive care. 1.) Contact with a primary care provider, not insurance status, was the key to differing rates of this complication, but having private insurance did increase the likelihood that a child would have a relationship with a primary care physician. 2.) Their finding that families that had Medicaid coverage for their children would seek health care for them, while families of uninsured children would not, is consistent with the findings from the Rand Health Insurance Experiment that families of poor children in cost-sharing plans were less likely to seek care for diagnoses related to trauma or accidents than families of poor children with free care. 3.) 4.) An analysis that went even further to separate insurance status from other factors that could affect children’s access to care found that children who had chronic conditions and special health care needs were more than twice as likely to be hospitalized if they had public or private insurance than if they were uninsured, adjusting for differences in need for hospitalization based on their conditions. Expanding Public Insurance Improves Access

Since providing uninsured children with publicly funded insurance improves their access to preventive and acute health services, families are more likely to report that their children’s health needs are being met. 5.) Lack of Health Insurance Is Only One Barrier to Care

Getting appropriate health care when it is needed can be difficult for children. Personal barriers can include parents’ lack of knowledge that care is needed and language differences between parents and providers. Children who have no insurance—even those who are sick or chronically ill or have special health care needs—get less health care than children who have insurance. But having health insurance is no guarantee that children will get appropriate, high-quality care. Having a stable source of insurance can help families use the health system for their children optimally over time. 1-8. 2. “Reconsidering the Effect of Medicaid on Health Care Services Use.” Health Services Research, Vol. “Race, Health, and Health Services.” American Journal of Public Health, Vol.
Why GAO Did This Study

Pursuant to a congressional request, GAO reported on the relationship between health insurance and health care access, focusing on: (1) what effect health insurance has on children's access to health care; (2) whether expanding publicly funded insurance improves their access; and (3) barriers besides lack of insurance that might deter children from getting health care.

What GAO Found

GAO noted that: (1) health insurance increased children's access to health care services in almost all the studies GAO analyzed; (2) most of the evaluations showed that insured children were more likely to have preventive and primary care than uninsured children; (3) insured children were also more likely to have a relationship with a primary care physician and to receive required preventive services, like well-child checkups, than uninsured children; (4) differences in access between insured and uninsured children held true even for children who had chronic conditions and special health care needs; (5) when ill, insured children were more likely to receive a physician's care for their health problems, such as asthma or acute earache; (6) in contrast, lack of insurance can inhibit parents from trying to get health care for their children and can lead providers to offer less-intensive services when families seek care; (7) several studies found evidence that low-income and uninsured children were more likely to be hospitalized for conditions that could have been managed with appropriate outpatient care; (8) two studies found that uninsured children sometimes received less-intensive hospital care than insured children; (9) while health insurance benefits differed and some excluded coverage for some basic health care needs, increasing the number of insured children increased the likelihood that more children would receive care; (10) although health insurance can considerably increase access, it does not guarantee entry into the health care system; (11) low family income and education levels, limited availability of neighborhood primary health care facilities, lack of transportation, and language differences are among the barriers to obtaining and appropriately using health care services; (12) both children who have no health insurance and those who have Medicaid coverage are more likely than privately insured children to face such barriers; and (13) to ensure access to high-quality care, public health and clinical experts recommend that children have a stable source of health insurance benefits that cover their health care needs, a relationship with a primary care provider that helps them obtain more complex care as needed, primary care facilities that are conveniently situated, and outreach and education for their families.