Medical home far less likely for publicly insured children

The concept of a medical home is increasingly important in primary care. Designed to create an excellent care environment among patients, parents, and care providers, the American Academy of Pediatrics (AAP) says that the medical home should be “accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.”

A new study has found, however, that children who may need comprehensive primary care the most-those with public health insurance-are far less likely to have a medical home meeting that description than privately insured children.

Analyzing data from the 2007 National Survey of Children’s Health phone survey of households with children aged 0 to 17 years, which was conducted by the National Center for Health Statistics, University of Michigan researchers asked parents about their child’s usual source of care, familiarity with a personal doctor/nurse, difficulty of obtaining referrals, access to family centered care, and communication between care providers.

Results indicated that 45% of children with public insurance met all 5 of these components, far less than the 67% of children with private insurance. Significantly fewer parents of publicly insured children reported that their child’s provider spent enough time, listened carefully, displayed sensitivity toward family values and customs, and provided needed information.

More than 90% of children in both groups reported having a usual source of care and a personal doctor or nurse.

“While we need to continue to assure adequate access to primary care for publicly insured children, we also need to pay attention to the care they receive once they’re in the door,” said researcher Joseph S. Zickafoose, MD, clinical lecturer in pediatrics and communicable diseases at the University of Michigan Medical School. “Particularly for family-centered care, we have a long way to go.”

Public insurance programs such as Medicaid and the Children’s Health Insurance Program currently cover one-third of US children.

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