The Maldistribution of Pediatric Providers as a Potential Driver of Reduced Educational Outcomes

Objective Despite evidence of a strong bidirectional connection between educational achievement and health, few studies have examined the link between these intertwining forces on a national level. This study takes advantage of a new population-level dataset to explicitly link child health access to academic outcomes in nearly every U.S. school district. Methods National data were used to construct and link district-level measures of child health access to district-level measures of third-grade achievement. Specifically, location data for over 256,000 practicing pediatricians and family physicians were linked to achievement data from 12,296 school districts. We include district-level rates of uninsured children as an additional measure of child health access. Results First, physician supply is unequally distributed across districts and their student populations. Second, districts that had higher physician supply tended to have higher test scores. This relationship is most pronounced for districts with relatively few pediatricians and family physicians. While the rate of uninsured children is largely correlated with community socioeconomic status, physician supply appears to operate independently of this measure. Conclusion Early childhood health and wellbeing are linked to cognitive performance and achievement in school. We provide evidence to illustrate an aspect of this relationship: children with less access to healthcare providers also do less well in school. The specific patterning of this finding suggests a need to reconsider how availability and access to pediatricians and family physicians is currently configured. Future research should examine whether a redistribution of the existing physician workforce could result in a net academic benefit for students.

Association between Health Insurance and Incidence of Death in Stateless Children in Tak Province, Thailand

This study assesses the association between health insurance and incidence of death in stateless children compared with uninsured children in Tak Province in Thailand. The study used electronic medical records of children aged between 0 and 15 who registered with selected health facilities between 01 January 2013 and 31 December 2017. The required data was obtained from ‘43-files database’ through the Provincial Public Health Office. The death case was used as a binary outcome variable while the exposure was three types of insurance: uninsured, stateless and the Universal Coverage Scheme (UCS). The age, sex and domicile of the children were used as covariates in the multivariate logistic regression. Of 164,435 registered children, 824 death cases were found during the study period. The study results suggest that insurance is associated with the reduced risk of deaths in stateless children. The odds of death is 86 per cent lower in the stateless insurees than in the uninsured children (adjusted odds ratio [AOR] = 0.242, 95% confidence interval [CI] = [0.136,0.403]; p < 0.001). The death is 69 per cent lower in the UCS beneficiaries than in the uninsured children (AOR = 0.385,95 per cent CI = [0.308,0.489]; p < 0.001). Age, sex and domicile of the children were independently associated with a varying risk of death.

Health insurance coverage for vulnerable children: two HIV orphans with Burkitt lymphoma and their quest for health insurance coverage in Kenya

The United Nations and WHO have summoned governments from low-income and middle-income countries to institute universal health coverage and thereby improve their population’s healthcare access and outcomes. Until now, few countries responded favourably to this international plea. The HIV/AIDS epidemic, a major global public health challenge, resulted in over 11 million orphans in sub-Saharan Africa. Extended families have taken responsibility for more than 90% of these children. HIV orphans are likely to be poorer and less healthy. Burkitt lymphoma is the most common childhood cancer in sub-Saharan Africa. If orphans need lifesaving chemotherapy, appointing legal guardians becomes necessary to access health insurance. However, rules and regulations involved may be unclear and costly. This hinders its access for poor families who need it most. Uninsured children risk hospital detention over unpaid medical bills and have lower survival. Our case report depicts the quest for health insurance coverage of two HIV orphans with Burkitt lymphoma in Kenya.

Free Vaccination and Immunization Coverage of Uninsured Children: The Case of the Vaccines for Children Program in the United States

Objective : Vaccines against contagious diseases have strong positive externalities as immunization protects not just the immunized but those around them. Out-of-pocket immunization costs are a common barrier to obtaining vaccines, especially for low-income families or those without health insurance in the United States. The Vaccines for Children (VFC) Program, initiated in October 1994, allows all uninsured children in the United States to receive free vaccinations. Despite its importance, few studies have focused on the effectiveness of this program. Using data from the National Immunization Survey (NIS) from 1995–1997 (N=51902), this study investigates how the introduction of this program affected the immunization coverage of uninsured children aged 19–35 months.Results : Accounting for variation in a child’s exposure to the program, I found that providing free vaccination correlated with an increase in the uptake of the entire spectrum of recommended vaccines, which included hepatitis B (Hep b) vaccine added to the recommended immunization schedule at the time. Further, despite the introduction of the program, uninsured children continue to have low immunization coverage. These findings suggest that improving immunization coverage for uninsured children by only reducing out-of-pocket vaccination costs may be insufficient and other factors may still influence vaccination decisions.

The health status and insurance affiliation of stateless children in Tak Province, Thailand

Purpose Statelessness is the worst possible form of violation of fundamental human rights which can lead to improper health systems management and serious adverse health outcomes in children. To address this, the Thai Cabinet introduced the Health Insurance for People with Citizenship Problem (HIPCP) in 2010. The purpose of this study is to examine the association between insurance affiliations and the health status of stateless children insured with the HIPCP. The presence of pneumonia was selected as a proxy for health status. The comparison groups were Thai children insured with the Universal Coverage Scheme (UCS) which was launched in 2002 and the uninsured children of low-skilled migrants in Thailand. Design/methodology/approach A retrospective study was conducted at four selected district hospitals: Mae Ramat Hospital, Phop Phra Hospital, Tha Song Yang Hospital and Umphang Hospital in Tak Province, located in northwestern Thailand. The study used the medical records of children aged 0-15 years who were admitted to the aforementioned hospitals between January 1, 2013 and December 31, 2017. Multivariate logistic regression model was applied with a binary response variable (ever diagnosed with pneumonia: yes/no). Exposure was three types of insurance status (uninsured, HIPCP and UCS) while covariates were age, sex, domicile and year of hospitalization of children. Findings Of 7,098 hospitalized children between 2013 and 2017, 1,313 were identified with pneumonia. After controlling for key covariates, multivariate results depicted that the odds of pneumonia was 4 per cent higher in stateless children insured with the HIPCP as compared with uninsured children but non-significant (adjusted odds ratio [AOR] = 1.040, 95 per cent confidence interval [CI] = [0.526, 2.160], p = 0.916). Similarly, the odds of pneumonia was 10 per cent higher in Thai children insured with the UCS as compared with uninsured children but non-significant (AOR = 1.100, 95 per cent CI = [0.594, 2.180], p = 0.767). The children who were hospitalized in 2017 were 26 per cent more likely to have pneumonia as compared with those who were hospitalized in 2013 with statistical significance (AOR = 1.260, 95 per cent CI = [1.000, 1.580], p = 0.050). Results remained robust after performing sensitivity analyses. Social implications This study suggests that health insurance is not associated with the health status of vulnerable children especially in the presence of multiple health interventions for uninsured and/or undocumented children living along the Thai–Myanmar border area. Further experimental studies are warranted to understand the causal relationship between insurance and health outcomes and to overcome the limitations of this observational study. Originality/value This study has discovered that age and domicile of children are independently associated with pneumonia. In comparison with the youngest age group (0-1 year), the older age groups presented a significantly lower odds for pneumonia. The children living in Phop Phra, Tha Song Yang and Umphang districts revealed a reduced risk for pneumonia as compared with children living in Mae Ramat district.

Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China

Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.

Examining the Impact of Child Adversity on Use of Preventive Health Care among Children

Child adversity has a negative impact on child and adult health. The present study aimed to determine whether adverse family experiences (AFEs) were associated with use of preventive health care (PHC) among children and whether insurance status affected this association. This study examined data from the 2011–2012 National Survey of Children’s Health (N = 88,849) and included responses for children ages zero to 17 years. Logistic regression models were used to estimate odds of using PHC from AFEs. Results were stratified by insurance status and confounders were accounted for. Among the entire sample and the insured, most AFEs were not associated with use of PHC. Among the uninsured, several AFEs—lived with parents or guardians who were separated, lived with parent or guardian who was incarcerated, witnessing or experiencing violence in the household, and living with anyone who had substance abuse problems—and the sum of AFEs were associated with increased use of PHC. Findings are consistent with newer research showing that some disadvantage or adversity is associated with more optimal use of PHC. In addition, uninsured children with a history of AFEs would benefit from insurance, given their increased use of PHC.