Date

May 2010

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Many children eligible for public insurance remain uninsured, despite efforts to increase the prevalence of children with health insurance. Outcomes for lack of health insurance for children include an increased likelihood of having an unmet medical need, no usual source of care or doctors visits, and delayed urgent care. Previous studies demonstrate that parent and child health insurance are related, and this association is integral to why eligible children remain uninsured. Objective: This study explores the association between the length of insurance coverage for adult Oregon Health Plan (OHP) members and whether children in the same household have health insurance. To better understand the circumstances of OHP adults with children living in the same household, socioeconomic, health and health care characteristics were compared for participants with varying lengths of health insurance. Methods: This is a secondary analysis of the Oregon Health Care Survey data, which includes three waves of surveys conducted at 6-, 18- and 30-months after OHP implemented increased cost-sharing and more stringent administrative rules. This survey oversampled for race and ethnicity, and also used iterative post-stratification raking to account for nonresponse at each wave. Participants were included in this study if they responded to all three surveys, and reported insurance information at 30 months for children in their household. Descriptive analyses compared the socioeconomic, health and health care characteristics for adults that had varying lengths of health insurance coverage. Multivariate logistic regression estimated the odds of having at least one uninsured child in the household at 30 months for different lengths of adult health insurance coverage, while adjusting for confounding variables. Results: This study included 559 study participants. The majority of participants were white (85.70%), female (80.32%) and English-speaking (94.00%). Adults with longer lengths of health insurance coverage were more likely to have a chronic illness including depression, had more health care utilization, and were more likely to be enrolled in OHP Plus (an OHP coverage group) at the beginning of the study. Adults with longer lengths of coverage were also less likely to report medical debt or financial strain at 30 months. Adult insurance length (p<0.01), race and ethnicity (p<0.01), highest education level (p<0.01), primary language (p<0.01), age at study start (p=0.22), OHP group type at study start (p=0.18), insurance type at 30 months (p<0.01) and medical debt at 30 months (p=0.21) were all found to be associated with having at least one uninsured child in the household at 30 months. Adults with longer lengths of health insurance coverage had significantly decreased odds of having at least one uninsured child in the household at 30 months. Primary language, race and ethnicity, age at study start and OHP group member type at study start were included in the adjusted logistic regression model for the association between having an uninsured child in the household at 30 months and length of adult insurance coverage. (Adjusted Wald test p<0.001). The association between length of adult insurance coverage and having at least one uninsured child at 30 months is modified by highest education level, as the association is stronger with high school or less education. Discussion: This study demonstrates that the longer an adult is insured, the less likely they are to have uninsured children. Therefore, increasing the prevalence of insured children in the United States, should involve shortening any gaps of health insurance coverage that caretakers in the same household have.

Identifier

doi:10.6083/M4T151NF

School

School of Medicine

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