Family structure differences in health care utilization among U.S. children

Abstract

This study explores the relationship between family structure and children's access to health care using data from the 2001–2003 waves of the child sample files from the U.S. National Health Interview Survey. Specifically, we investigate the extent to which family structure types predict children's utilization of preventive health care, and barriers to care. We then explore whether observed differences across family structures can be attributed to differences in demographic characteristics, socioeconomic status (SES), and child health status. Using logistic regression models, we document substantial variation in health care usage and barriers to health care across a variety of family structures. Of note is the finding that the children of single mothers demonstrate extremely different patterns of health care access than do the children of single fathers, and the importance of SES as a risk factor for diminished levels of access to health care varies by family type. SES plays a major role in mediating the relationship between access to care for children in single mother and cohabiting families (when contrasted against children in two married parent families), but less of a role for children living with stepparents, a single father, or with parents and other relatives.

Introduction

Children's access to routine and preventive health care is a vital determinant of their life chances. Preventive health care provides an opportunity for monitoring development, giving immunizations, and detecting acute and chronic conditions (American Academy of Pediatrics, 2000). Often, routine health care can prevent health problems from occurring or detect them early enough that needed treatment is less complex, invasive, or expensive than otherwise would have been necessary. However, not all children have access to quality preventive and routine health care (Fleming and Charlton, 1998, Heck and Parker, 2002).

Family structure plays an important role in shaping children's access to health care. Children in single parent families are significantly less likely to receive certain types of preventive care and are less likely to have a usual source of such care compared to peers in two parent families (Fleming and Charlton, 1998, Heck and Parker, 2002). Single parents are also less confident in their ability to access needed medical care for their children (Fairbrother et al., 2005), and are more likely to delay or skip such care (Moreno, 1989). Family structure is also correlated with several characteristics, including socioeconomic status (SES), that shape children's access to health care (McLanahan and Carlson, 2002, Schor, 2003). Additionally, a great deal of research has focused on differences between single parent and two parent families; while fruitful, this type of research often overlooks much of the existing diversity in family structure types, such as the differences between families with two biological or adoptive parents and stepparent families, or the difference between single mother and single father families. Yet, growing evidence suggests that much information is missed when the specific details regarding family forms are ignored (e.g., Case & Paxson, 2001).

This study attempts to provide more detailed information about the effects of family structure on children's access to health care using three waves of data (2001–2003) from the National Health Interview Survey (NHIS). Specifically, we investigate the extent to which a wide variety of family structure types predict children's access to care, and the consistency of this predictive power across several measures of utilization of health care and barriers to care. We then explore whether we can account for differences in access to care across family structures by controlling for differences in background characteristics across family types.