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Healthy Kids Insurance and Experiences of Medical Home Quality for Vulnerable Children

Stevens, Gregory D. PhD, MHS; Cousineau, Michael R. DrPH; Pickering, Trevor A. MS; Lee, Paul MPH

doi: 10.1097/MLR.0b013e318215d0ef
Original Articles

Objectives To examine the relationship of enrollment in Healthy Kids insurance (locally funded insurance products for low-income children ineligible for other public insurance) with parent-reported experiences of primary care medical home quality.

Methods A cross-sectional survey of parents of 4011 children stratified by established enrollees in Healthy Kids (enrolled 1 y or longer), new enrollees (less than 1 y), and children on a waitlist. We examined differences across groups in having an ongoing source of primary care, and experiences of 6 features of a medical home—accessibility, continuity, comprehensiveness, contextual knowledge, communication, and coordination—and a summary medical home measure.

Results Compared with waitlisted children, new and established enrollees were more likely to have a regular source of care [odds ratio (OR)=2.49; 95% confidence interval (CI): 1.74-3.57 and OR=6.51; CI: 4.64-9.13, respectively] and a personal doctor or nurse (OR=3.41; CI: 2.42-4.80 and OR=7.00; CI: 5.07-9.66). Among those with a regular source of care and visit in the past year, new and established enrollees reported better medical home experiences in 4 and 6 of the 7 measures, respectively.

Conclusions Despite many barriers to care for vulnerable children, Healthy Kids enrollment was positively associated with having an ongoing source of primary care and better medical home experiences. As these children are mostly left out of healthcare reform, Healthy Kids programs may be a good model for other counties and states to help to connect such children to primary care.

Center for Community Health Studies, Department of Family Medicine, University of Southern California Keck School of Medicine, Alhambra, CA

The study was approved by the USC Office for the Protection of Research Subjects. The authors do not have any financial or other conflicts of interest regarding the results that are presented in this study. This project was funded by The California Endowment and First 5 California.

Reprints: Gregory D. Stevens, PhD, MHS, Center for Community Health Studies, University of Southern California Keck School of Medicine, 1000 South Fremont Avenue, Unit #80, Alhambra, CA 91803. e-mail:

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