Methods Cross sectional study of a convenience sample of parents who completed surveys between July 2009 and September 2009 while their child(ren) were being seen at a practice within the Southwestern Ohio Ambulatory Research Network (SOAR-Net).
Results 2164 parents of children with health insurance were asked to participate and 186 refused, 1978 parents completed the survey. 84.9% were mothers, 75.4% were Euro-American, 91.2% reported at least a high school education, 61.2% of study children had some form of private insurance and the remainder had public insurance. During the 12 months prior to the survey 5.5% of index children did not see a recommended specialist, 4.7% did not have a lab test and 8.7% did not fill a prescription because of parents' inability to pay for it. 7.8% reported that their child's health "had suffered" due to the cost of care. Compared to three years ago, 16.7% of parents reported it was more difficult to obtain the health care their children needed; this was more likely to occur in private insurance vs public insurance subgroups (17.8% vs 12.8%, p<0.0001) and middle income (about 20%) vs lowest and highest income subgroups (about 13%, p<0.0001). Overall, 13.1% of parents reported not being able to comply with AT LEAST one of their child's clinician's recommendations in the past 12 months due to trouble paying for it. After controlling for other demographic variables using logistic regression, family's annual income between $15,000 and $34,999 was the strongest predictor of child's health suffering due to inability to pay, AOR=5.1(95% CI, 2.6-9.9)and underinsurance, AOR=5.7 (95% CI, 3.4-9.7), annual income >$75,000 was the referent group for both adjusted odds ratios (AOR).
Conclusion: About one in six parents reported that it has become more difficult to obtain necessary heath care for their child(ren) over the past three years. The lowest and highest income subgroups of parents were less likely to report increasing difficulty obtaining necessary health care for their children presumably because the lowest subgroup had public insurance and the highest had better private insurance compared to middle income subgroups (annual family income between $15,000 and $75,000). Children's underinsurance and their parents' subsequent failure to comply with clinicians' recommendations has become a major public health issue early in the 21st century. A large sample (N at least 1000) of SOAR-Net families responding to the same underinsurance survey in July-September 2010 should be available for comparison with the 2009 data set described above at the American Academy of Pediatrics' Annual Meeting, October, 2010.