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Emmanuel M. Ngui, DrPH, Center for the Advancement of Urban Children, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, (414) 456-4302, engui@mail.mcw.edu
Purpose: The persisting disparities in access and use of health care services, after controlling for economic factors, have frequently been attributed to non-financial barriers (NFB). However, there is dearth of research quantifying the effect of non-financial barriers on health care use by children. This study examined the factor structure of several non-financial structural barriers and the effects of these barriers on health care utilization by children. Method: Confirmatory Factor Analysis was used to examine the underlying factor structure of the several non-financial structural barrier items in 1999 and 2000 National Health Interview Survey. Multivariate logistic regression models were estimated to examine the independent effect of a subset of NFB (provider related organizational structural barriers [PROBS] and transportation barriers) on health care use controlling for other factors. Results: Four PROBS items (appointment setting, contacting provider by phone, waiting time, services hours) were highly correlated (r>0.60) and accounted for most of the variance and factor loading. These four items had positive loading ranging from 0.64 to 0.94. Difficulties setting up appointments accounted for most of the variance (0.89) of the underlying construct. Transportation barriers were moderately correlated (r<0.58) with the other items and had the lowest variance and factor loading. In multivariate analysis, PROBS were associated with increased likelihood of making an emergency room visit (OR 1.12; 1.09-1.14). However, contrary to the hypothesized relationship, delaying care due to PROBS was associated with increased physician (OR 1.08; 1.04-1.12) and specialist (OR 1.07; 1.03-1.10) visits but not well child services (OR 1.02;0. 99-1.05). Transportation barriers were only associated with increased well child checkup visits (OR 1.52; 1.07-2.15) but not the other services. Conclusion: Results of this study suggest that four of the five non-financial structural barrier items in NHIS measure a provider related organizational barriers while transportation measures a family related barrier to care. The association of PROBS with increased use of physician and specialty services was surprising since it suggests that delaying care due to these barriers does not decrease children’s use of health care services. However, these finding are consistent with results of other studies conducted among the elderly population, and may reflect increased exposure to PROBS among children who frequently use services. Efforts to promote timely access to care for children will requires a better understanding of non-financial barriers and the development of interventions to reduce these barriers.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.