Geographic Disparity in Health Insurance




Master, Hiral
Fulda, Kimberly


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Purpose: The purpose of this study is to identify factors associated with having adequate health insurance for children with special health care needs (CSHCN) differ by geographic region. Methods: The proposed analysis was conducted on the 2009-2010 databases of the NS-CSHCN using SAS which accounted for complex survey weighting and sampling design. The analysis included examining the overall distributions of variables using means and frequencies. Distributions of variables were examined for those who had any kind of health insurance and those who did not. Differences in whether having health insurance or not by region were analyzed using chi-square test and logistic regressions were performed. Odds ratios and 95% CIs were examined. Results: Out of total population, 10110 were insured for entire year while 919 were insured at some point during the year. Education level, family structure and financial condition of the family have significant effect on the insurance status of CSHCN. Based on chi square analysis, education level of the household had significant effect on insurance status of CSHCN in northeast and south and west region while family structure, number of missed school days of CSHCN, Family financial burden was significant for all region. Odds ratio obtained from logistic regression where individuals who were uninsured was used as reference. Thus, odds of having insurance were higher in individuals with higher education in all the regions. Odds of CSHCN being insured was significantly lesser in northeast, south for Hispanics while was significantly higher in west for blacks compared to white non- Hispanics. Odds of CSHCN being insured was significantly lesser in midwest, south in family consisted of only mother and was significantly lesser in northeast in family consisted of parent stepfamily when compared to either biological or adopted parents. Odds of CSHCN being insured was significantly higher in midwest if child’s problems never affected ability to do compared to those where their ability was usually affected. Odds of CSHCN being insured was significantly higher in midwest, northeast, south in family with no financial burden compared to who had financial burden. Conclusion: Policies should be directed to increase the educational awareness, focus on Hispanic groups for insurance, expand the insurance plans that will accommodate the families having financial burden.