Photo: Study co-authors Gregory D. Stevens, Ph.D., and Michael R. Cousineau, Dr.P.H.
Undocumented children who have access to health insurance
are healthier and more engaged in school than those without insurance,
according to researchers at the Keck
School of Medicine of the University
of Southern California (USC).
Their data is the first to show a direct health benefit to children
from what primary care practitioners call a “medical home,” which is
medical care that is accessible, continuous, comprehensive,
coordinated, family-centered, compassionate and culturally effective.
“If you can connect kids to medical homes, there are potentially big
pay-offs,” said Gregory D.
Stevens, Ph.D.,
assistant professor of family medicine at the Keck School and lead
author of two recently published studies about medical homes. “We found
that there is a strong association between high-quality medical care
and health improvement and school engagement.”
A family-centered medical
home, as defined by the American
Academy of Pediatrics,
is not a building or service, but an approach to provide patients with
comprehensive primary care. Dubbed by some as the future of family
medicine, the medical home and other patient care models are encouraged
in the health reforms passed into law by the Patient Protection and
Affordable Care Act of 2010.
While those health reforms do not apply to undocumented immigrants,
co-authors Stevens and Michael R.
Cousineau, Dr.P.H.,
associate professor of research in the Keck School’s Department of
Family Medicine, were tasked with evaluating the efficacy of Healthy
Kids, a decade-old county-led program that provides affordable health
insurance for children of low-income families who don’t qualify for
state insurance programs like Medi-Cal and Healthy Families — namely,
undocumented children. At the time of data collection in 2009, Healthy
Kids was offered in 24 of 58 California counties, providing about
70,700 children statewide with comprehensive medical, dental and vision
coverage.
The researchers surveyed 4,011 children from 21 of the 24 Healthy Kids
programs (including the largest in Los Angeles). The sample consisted
mostly of Latino children in low-income, undocumented and predominantly
Spanish-speaking families. Nearly 95 percent of the 2,230 families
actually reached cooperated. The sample was divided into three groups:
established enrollees (in the program for one year or longer), new
enrollees (less than one year) and children on a waitlist.
In a study that appears in the September issue of Medical Care,
the researchers found that those enrolled in Healthy Kids were more
likely to have a regular source of health care and reported better
medical home experiences than the children on a wait list. Children who
were enrolled in the program for more than a year reported the best
medical home experiences among the three groups.
In a separate study that was published online by Health Services Research,
the researchers found that children who reported better medical home
experiences missed fewer days at school and performed better overall,
in math and in reading. For example, for every one-point increase in
the medical home total score, the odds of missing fewer than three
school days due to illness or injury in the past school year increased
by 12 percent. Among the measured indicators of medical home quality,
access was most strongly associated with improved health and school
engagement.
“It supports the argument to keep providing affordable health insurance
for undocumented kids,” said Stevens. “Since these children are going
to be left out of health care reform, the studies show the unique value
of these public-private programs — like Healthy Kids — that were
created to give them coverage.”
Public health officials agree.
“These families who have no other access to health insurance, they are
so grateful to get their child into the health care system,” says Kena
Burke, former director of the Healthy Kids program in San Luis Obispo,
Calif. “For the most part, children are well. But, if they contract an
ear infection or common cold, and their parents don’t have access to
insurance and have to pay cash — economic choices have to be made:
Should I pay rent or give medical care to my children? It’s hard.”
Due to reduced funding, the Healthy Kids program has shrunk in some
counties. But Alison Lobb, an analyst with California Coverage
& Health Initiatives
(the state association of local organizations that connect low-income
people with health insurance), says they are exploring alternatives to
keep all kids — regardless of immigration status or income — connected
to medical homes.
“We won't abandon these kids who can’t take advantage of these health
reforms,” Lobb said. “We feel the ideal way is through insurance
coverage, but when that’s not possible, we are seeking other ways of
connecting kids with care — and we feel the medical home is the ideal
way to do it.”
Stevens and Cousineau’s research was funded by The California Endowment, a
private health foundation, and First
5 California, a tobacco tax-funded state agency focused on
providing children’s services.