The effect of nonfinancial structural barriers on health care utilization by children with and without special health care needs.

摘要

Disparities in health care have frequently been attributed to non-financial barriers. However, there is dearth of research quantifying the effect of non-financial barriers on health care use by children, particularly those with special health care needs (CSHCN). Data from the 1999 and 2000 National Health Interview Surveys (NHIS) were used to examine the effect of five non-financial structural barriers (NFSB) related to appointment setting, contacting provider by telephone, waiting time, services hours, and transportation on health care use by children with and without special health care needs.; Method. Confirmatory Factor Analysis was used to examine the factor structure of the five NFSB items. Estimation of the independent effect of the NFSB on health care use controlling for other factors was done using logistic regression models.; Results. Four NFSB items (appointment setting, contacting provider by phone, waiting time, services hours) were highly correlated and accounted for most of the variance and factor loading. These four items appear to measure Provider Related Organizational Barriers (PROBS). Difficulties setting up appointments accounted for most of the variance of the underlying construct. Transportation barriers were moderately correlated with the other items and had the lowest variance and factor loading.; Among children with and without special needs, delaying care due to PROBS was associated with increased use of emergency room (ER), physician, specialist and allied health services, but not dental or well child services. Likewise, transportation barriers were associated with increased use of ER, specialist, and well child visits, and decreased use of dental services among all children. For CSHCN, transportation barriers were only associated with higher use of ER and lower use of dental services.; Conclusion. Four of the five NFSB items in NHIS measure a common underlying construct related to difficulties setting appointments. The results suggest that delaying care due to NFSB does not decrease children's use of health care services except for dental services. On the contrary, these NFSB, were associated with increased use of almost all services. This finding may reflect increased exposure to NFSB among children who frequently use services. Future studies need to examine other dimensions of non-financial barriers.