From the Institute for Health Policy Studies (Dr Newacheck, Ms Pearl, and Dr Hughes) and the Department of Pediatrics (Dr Newacheck), School of Medicine, University of California, San Francisco; and the School of Public Health and the Department of Pediatrics, School of Medicine, University of California, Los Angeles (Dr Halfon).
Context.— Congress enacted a series of laws beginning in the mid 1980s to expand
Medicaid eligibility for children, especially those in poor families. As a
result, Medicaid enrollment of children has nearly doubled over the past decade.
Objective.— To assess the effectiveness of Medicaid in improving access to and use
of health services by poor children.
Design.— Analysis of cross-sectional survey data from the 1995 National Health
Interview Survey. Poor children with Medicaid were compared to poor children
without insurance and nonpoor children with private insurance.
Setting and Participants.— A total of 29,711 children younger than 18 years (3716 poor children
with Medicaid, 1329 poor children without insurance, 14,609 nonpoor children
with private insurance, and 10,057 children with other combinations of poverty
and insurance status) included in a nationally representative stratified probability
sample of the US noninstitutionalized population.
Main Outcome Measures.— Usual source of care, access to a regular clinician, unmet health needs,
and use of physician services.
Results.— Poor children with Medicaid compared to poor children without health
insurance experienced superior access across all measured dimensions of health
care, including presence of a usual source of care (95.6% vs 73.8%), frequency
of unmet health needs (2.1% vs 5.9%), and use of medical services (eg, ≥1
physician contact in past year) (83.9% vs 60.7%). Poor children with Medicaid
compared to nonpoor children with private insurance used similar levels of
physician services (83.9% vs 84%), but were more likely to have unmet health
needs (2.1% vs 0.6%) and were less likely to have a usual source of care (95.6%
Conclusion.— Medicaid is associated with improvements in access to care and use of
services. However, there remains room for improvement when Medicaid is judged
against private health insurance. The Balanced Budget Act of 1997 contains
several Medicaid provisions that could stimulate further improvements in access
for poor children.
Newacheck PW, Pearl M, Hughes DC, Halfon N. The Role of Medicaid in Ensuring Children's Access to Care. JAMA. 1998;280(20):1789-1793. doi:10.1001/jama.280.20.1789