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Paul W. Newacheck, DrPH; Michelle Pearl, MPH; Dana C. Hughes, DrPH; Neal Halfon, MD, MPH

JAMA. 1998;280:1789-1793.

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% vs 97.4%).

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.

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).

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