Objectives: To explore the extent to which, among working poor families, uninsured immigrant children experience more barriers to care than uninsured nonimmigrants, and compare these differences to those of insured children. Methods: We used data from the 2001 California Health Interview Survey, a randomized, population-based telephone survey conducted from November 2000 through September 2001. Financial and nonfinancial access to health care and utilization of health services were examined for 3,978 nonimmigrant and 462 immigrant children and adolescents under the age of 18 years. We compared differences in crude rates across four subgroups (insured immigrants, uninsured immigrants, insured nonimmigrants, uninsured nonimmigrants) and in adjusted models controlling for socioeconomic and immigration characteristics, parental language, health status, and other demographic factors. Results: More immigrant than nonimmigrant children lacked health insurance at the time of the interview (44% vs. 17%, p < 0.0001). Among the uninsured, immigrants had higher odds of perceiving discrimination (11% vs. 5%, p < 0.05) and postponing emergency room (ER) (16% vs. 7%, p < 0.05) and dental care (40% vs. 30%, p < 0.05) after controlling for covariates. Among the insured, immigrants fared worse on almost every access and utilization outcome. Among insured immigrants, child and parent undocumented status and having a non-English-speaking parent contributed to missed physician and ER visits. Conclusions: Disparities in access and use remain for immigrant poor children despite public insurance eligibility expansions. Insurance does not guarantee equitable health care access and use for undocumented children. Financial and nonfinancial barriers to health care for immigrant children must be removed if we are to address disparities among minority children.
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REFERENCES
Ku L. The number of Americans without health insurance rose in 2001 and continued to rise in 2002. Int J Health Ser 2003;33(2):359–67.
Holahan J, Dubay L, Kenney G. Which children are still uninsured and why. Future Child 2003;13(1):55–79.
Lessard G, Ku L. Gaps in coverage for children in immigrant families. Future Child 2003;13(1):101–15.
Guendelman S, et al. Differential access and utilization of health services by immigrant and native-born children in working poor families in California. J Health Care Poor Underserved 2002;13(1):12–23.
Guendelman S, Wyn R, Tsai YW. Children of working low-income families in California: Does parental work benefit children's insurance status, access, and utilization of primary health care? Health Ser Res 2000;35(2):417–41.
RAND. Immigrants Increasingly Occupy the Bottom of the Labor Market [cited 2003 Oct 20]; Available at: http://ca.rand.org/stats/popdemo/popdemo/html.
Bean F, Lowell L. Immigrant employment and mobility opportunities in California. Mexican American legal defense fund [cited 2003 Oct 8]; Available at: http://www.maldef.org/publications/index.cfm.
Guendelman S, Schauffler H, Pearl M. Unfriendly shores: How immigrant children fare in the U.S health system. Health Affairs 2001;20(1):257–66.
Ku L, Waidmann T. How Race/Ethnicity, Immigration Status, and Language Affect Health Insurance Coverage, Access to and quality of care among the low-income population.Washington, DC: Kaiser Family Foundation, 2003.
Schur C, Berk M, Good C, Gardner E. California's Undocumented Latino Immigrants. A report on access to health services. Kaiser family foundation working paper, May 1999.
California Health Interview Survey. CHIS 2001 Methodology Series: Report 1—Sample Design. Los Angeles, CA: UCLA Center for Health Policy Research, 2002.
California Health Interview Survey. CHIS 2001 Methodology Series: Report 2—Data collection Methods. Los Angeles, CA: UCLA Center for Health Policy Research, 2002.
California Health Interview Survey. CHIS 2001 Methodology Series: Report Response Rates. Los Angeles, CA: UCLA Center for Health Policy Research, 2002.
Guendelman S, Angulo V, Oman D. Access to health care for children and adolescents in working poor families: Recent findings from California. Medical Care 2005;43(1):68–78.
California Health Interview Survey. The CHIS 2001 Sample: Response Rate and Representativeness. Los Angeles, CA: UCLA Center for Health Policy Research, 2003.
California Health Interview Survey. Technical Paper No. 1. UCLA Center for Health Policy Research, December 2003.
Ku L, Matani S. Left out: Immigrants’ access to health care and insurance. Health Affairs. 2001;20(1):247–256.
Granados G, et al. Health care for Latino children: impact of child and parental birthplace on insurance status and access to health services. Am J Public Health. 2001;91(11):1806–07.
Halfon N, Inkelas M, Wood D. Non-financial barriers to care for children and youth. Ann Rev Public Health 1995;16:447–72.
Holahan J, Pohl M. Changes in insurance coverage: 1994-2000 and beyond. Health Affairs 2003;Web Supp:W162–W172.
STATA Corporation, College Station, Texas. 2002.
Thamer M, Richard C, Waldman Casebeer A, Fox R. Health insurance coverage among foreign-born US residents: The impact of race, ethnicity, and length of residence. Am J Public Health 1997; 87(1):96–102.
Milgrom P, Lloyd M, King B, et al. An explanatory model of the dental care utilization of low-income children. Medical Care 1998;36(4):554–56.
Maida C. Access to health care for California's immigrants. [cited 2003 Nov 17]. Available at: http://www.health careoptions.ca.gov/csunimmigrant.asp.
Flores G, et al. Access barriers to health care for Latino children. Arch Pediatric Adolesc Med 1998;152(11):1119–1125.
Newacheck P, Stoddard J, Hughes D, Pearl M. Health insurance and access to primary care for children. The New Engl J Med 1998;338(8):512–19.
Geronimus AT, Bound J, Waidmann TA. Poverty, time, and place: variation in excess mortality across selected US populations, 1980-1990. J Epidemiol Community Health 1999 ;53(6):325–34.
Finkelstein J. California lawsuit challenges medicaid reimbursement cuts [cited 2004 Jan 4]; Available at: http:// www.ama-assn.org/amednews/2003/12/01/gvsc1201.htm.
Nikos K, Lopp R, Warren P. California Medical Association and Coalition of Health Care Providers File Lawsuit Against State to Stop Illegal Medi-Cal Cuts. [cited 2004 Jan 4] Available at: http://www.cmanet.org/publicdoc.cfm/708 /207/press/280.
Currie J. Do Children of Immigrants Make Differential Use of Public Health Insurance (1996)? Labor and Population Program: Working Paper Series 96-13. DRU-1461-RC, July.
Brown E, Wyn R, Yu H, Valenzuela A, Dong L. Access to health insurance and health care for children in immigrant families. In: Donald Hernandez (Ed.) Children of immigrants: Health, adjustment, and public assistance. Committee on the health and adjustment of immigrant children and families. Washington, DC: National Academy Press, 1999
Infante-Revard C, Jacques L. Empirical study of parental recall bias. Am J Epidemiol. 2000 1;152(5):480–486.
Child and Family Coverage Technical Assistance Center. Comparison of Counties Children Health Initiatives. San Carlos, CA: Institute for Health Policy Solutions; 2003 [cited 2003 Oct 25]. Available at: http://www.cfctac.org/ countyinitiatives/.
National Immigration Law Center—Health care issue brief. Immigrant-friendly health coverage, outreach, and enrollment. 2002 [cited 2003 Nov 15]. Available at: http://www.nilc.org/immspbs/health/Issue_Briefs/Immigrant-Friendly_App_Enrllmnt.PDF.
Butler S. Commentary. Med Care Res Rev 2003;60(2):82S–88S.
US Department of Health and Human Services. Healthy People 2010: Conference Edition Vol 1, Washington, DC: US Department of Health and Human Services; 2000.
ACKNOWLEDGMENTS
Funding for this study was obtained from the DHHS Agency for Health care Research and Quality (grant # HS13411-01), the UC Berkeley Center for Latino Policy Research, and the UC Berkeley Center for Child and Youth Policy. The authors thank Lora Santiago for editorial assistance.
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Guendelman, S., Angulo, V., Wier, M. et al. Overcoming the Odds: Access to Care for Immigrant Children in Working Poor Families in California. Matern Child Health J 9, 351–362 (2005). https://doi.org/10.1007/s10995-005-0018-2
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DOI: https://doi.org/10.1007/s10995-005-0018-2