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Comparing Types of Health Insurance for Children: A Public Option versus a Private Option

DeVoe, Jennifer E. MD, DPhil*; Tillotson, Carrie J. MPH*; Wallace, Lorraine S. PhD; Selph, Shelley MD; Graham, Alan MD§; Angier, Heather MPH*

doi: 10.1097/MLR.0b013e3182159e4d
Original Articles

Background Many states have expanded public health insurance programs for children, and further expansions were proposed in recent national reform initiatives; yet the expansion of public insurance plans and the inclusion of a public option in state insurance exchange programs sparked controversies and raised new questions with regard to the quality and adequacy of various insurance types.

Objectives We aimed to examine the comparative effectiveness of public versus private coverage on parental-reported children's access to health care in low-income and middle-income families.

Methods/Participants/Measures We conducted secondary data analyses of the nationally representative Medical Expenditure Panel Survey, pooling years 2002 to 2006. We assessed univariate and multivariate associations between child's full-year insurance type and parental-reported unmet health care and preventive counseling needs among children in low-income (n=28,338) and middle-income families (n=13,160).

Results Among children in families earning <200% of the federal poverty level, those with public insurance were significantly less likely to have no usual source of care compared with privately insured children (adjusted relative risk, 0.79; 95% confidence interval, 0.63-0.99). This was the only significant difference in 50 logistic regression models comparing unmet health care and preventive counseling needs among low-income and middle-income children with public versus private coverage.

Conclusions The striking similarities in reported rates of unmet needs among children with public versus private coverage in both low-income and middle-income groups suggest that a public children's insurance option may be equivalent to a private option in guaranteeing access to necessary health care services for all children.

*Departments of Family Medicine, Portland, OR

Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN

Public Health and Preventive Medicine

§Pediatrics, Oregon Health & Science University, Portland, OR

Funding Sources: This project was directly supported by grants 1 K08 HS16181 and 1 R01 HS018569 from the Agency for Healthcare Research and Quality (AHRQ) and the Oregon Health & Science University Department of Medicine. This publication received indirect support from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. These funding agencies had no involvement in the design and conduct of the study; analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. AHRQ collects and manages the Medical Expenditure Panel Survey.

Disclosures: The authors have no financial conflicts of interest to disclose.

Reprints: Jennifer E. DeVoe, MD, DPhil, Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Rd, mailcode: FM, Portland, OR 97239. e-mail:

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