Access to health care: A study of underinsurance among Michigan's children.

Abstract

The purpose of this research was to investigate underinsurance among privately insured children in Michigan and its effect on access to health care. The research was based on secondary analysis of data from the 1989 Health Insurance Survey of Michigan which represented a cross-section of the State's population including 833 children. The results revealed that 24% of Michigan's children were underinsured. Children with the highest rates of underinsurance were those between ages 9 and 17 (rate = 28%) and those living in southwest Michigan (rate = 30%). When the major breadwinner in the family worked in manufacturing their underinsurance was the highest of any group (rate = 32%). The lowest rate, 12%, was found among children whose working parent was employed in the service industry. Income was a significant predictor of underinsurance among children from families earning less than $30,000 a year being at higher risk (Odds ratio = 1.562; p = .1006). Several business and employee characteristics including size and age of business and length of time with employer were more significant predictor of underinsurance, however. Family composition and health status were not significant predictors of underinsurance. Underinsurance is a function of employment and economic marginality but not a familial marginality. Access problems associated with underinsurance included inability to afford care, refused payment by insurance, red tape sufficient to cause treatment delay, and non-coverage of treatments, physician fees and prescription fees by insurance. However, some of these same access problems were also reported by the adequately insured. Underinsurance is a significant problem among Michigan's children. The results of this study suggest that occupational characteristics are the most significant predictors of underinsurance in children and that access problems occurred equally among the underinsured and the adequately insured. These findings further suggest that mandating health insurance coverage for children will not be sufficient to assure them access to health care. They will still need health care facilities to provide services for them. Nonetheless, extending adequate benefits to dependent children will be helpful in diminishing the problem of underinsurance.