Health Care for Latino Children: Impact of Child and Parental Birthplace on Insurance Status and Access to Health Services

Abstract

Objectives. This study sought to assess the impact of child and parental birthplace on insurance status and access to health care among Latino children in the United States.

Methods. A cross-sectional, in-person survey of 376 random households with children aged 1 to 12 years was conducted in a predominantly Latino community. Children's insurance status and access to routine health care were compared among 3 child–parent groups: US born–US born (UU), US born–immigrant (UI), and immigrant–immigrant (II).

Results. Uninsured rates for the 3 groups of children were 10% (UU), 23% (UI), and 64% (II). Rates for lack of access to routine health care were 5% (UU), 12% (UI), and 32% (II).

Conclusion. Latino children of immigrant parents are more likely to lack insurance and access to routine health care than are Latino children of US-born parents.

The Latino community is one of the fastest growing ethnic groups in the United States; it now constitutes 8% of the US population, and soon it will be the largest minority group.1–3 Of 9 million Latino children nationally, 25% are not covered by health insurance.4 In California, Latino children aged 0 to 17 years are 3 times as likely as their White counterparts to be uninsured.5 They also are more likely to encounter deficiencies in access to care.6 During the past decade, immigration patterns throughout the United States have resulted in families whose members have differing legal status.7 Latino children frequently live in “mixed status” families composed of noncitizen parents and US-born citizen children. Roughly 85% of all immigrant families in the United States are of “mixed status.” 8

Previous studies have shown that despite higher levels of potential eligibility, noncitizen families are less likely to have health insurance.6 In this study, we attempted to measure the impact of parental and child birthplace on insurance status and access to care among Latino children.

METHODS

For a 6-week period during the summer of 1997, we conducted household surveys to determine the health care access of children in the community of Wilmington, a poor, urban, predominantly Latino, working-class community within the city of Los Angeles. Using random cluster sampling, we surveyed a total of 376 eligible households to represent the target population, based on adjusted 1990 census data. Households were considered eligible if at least 1 child in the home was aged 1 to 12 years. Trained medical students interviewed the primary caregiver for a randomly chosen eligible child in the caregiver's preferred language (English or Spanish). The overall response rate was 66%; we assume that nonresponders are similar, if not identical, to those who were difficult to contact.9

We divided the children into 3 categories on the basis of their own and their parents' immigration status. The first group consisted of US-born children with US-born parents (UU); the second group consisted of US-born children with immigrant primary caregiver (UI)—the “mixed status” group; the third group consisted of immigrant children with immigrant parents (II).

We compared the 3 groups with respect to differences in health insurance status and access to care. A child was considered insured if the child was enrolled in some form of public or private health insurance at the time of the interview (children enrolled in emergency Medicaid only were excluded). Access to health care was defined as positive if a child had a usual source of care for routine well-child examinations.

We conducted χ² tests to look for differences in parental sociodemographic factors among the 3 groups. We also looked at the impact of the parents' and child's immigration status on access to health care and the insurance status of the child. We used odds ratios to determine the most important factors in whether a child had access to care.

RESULTS

Parental Sociodemographic Variables and Parent–Child Birthplace

In the UU group, 97% of primary caregivers were English speaking, and 36% had more than a 12th-grade education. In contrast, the parents in the UI and II groups were predominantly Spanish speaking (UI = 55%, II = 69%), and only 14% of the parents in these groups had more than a 12th-grade education. The UI and II groups had a much higher proportion of 2-parent households: 85% for the UI group and 71% for the II group, compared with only 46% for the UU group. There were no significant differences in the employment patterns of the 3 groups. In all 3 groups, 80% of primary caregivers had full-time or part-time employment.

Child's Insurance Status and Access to Care in Relation to Parent–Child Birthplace

There were significant differences among the 3 groups with regard to the child's insurance status and access to care (Table 1 ▶). In the UU group, 11% of children lacked insurance, compared with 23% in the UI group and 64% in the II group. Thus, the rate of lack of insurance among children in the UI group was double that among children in the UU group; children in the II group were 6 times as likely to lack insurance as children in the UU group. Whereas 5% of children in the UU group did not have a regular source of care, the rate was almost 2.5 times as high for children in the UI group (12%) and more than 6 times as high for children in the II group (32%).

TABLE 1—

Rates of Uninsured Status and Lack of Routine Source of Care Among Latino Children in an Urban Community, Based on the Children's and Their Parents' Place of Birth

	UU (n = 114)	UI (n = 191)	II (n = 54)
Uninsured, %	10.81	22.75	64.15
No routine source of care, %	4.59	11.64	32.08

Note. Latino families with a child aged 1–12 years. All values indicate column percentages. UU = US-born children of US-born parents; UI = US-born children of immigrant parents; II = immigrant children of immigrant parents. All values significant at P < .001.

Multivariate Analysis

Table 2 ▶ lists odds ratios and 95% confidence intervals for the most important predictors of whether a child has access to care. The insurance status of the child was the most important predictor, followed by the child's birthplace and the parents' birthplace. Language and employment status were also significant determinants, but language is associated with the immigrant status of the parent.

TABLE 2—

Predictors of Routine Source of Care Among Latino Children Aged 1–12 Years in an Urban Community

	OR (95% CI)
Parent US borna	3.39 (1.43, 8.04)*
Child US bornb	4.63 (2.32, 9.29)*
Insuredc	19.25 (8.11, 53.43)*
Employedd
Caregiver	2.51 (1.40, 4.50)*
Partner	0.46 (0.21, 1.01)
Marriede	1.76 (0.85, 3.64)
Primary language Englishf	4.55 (1.87, 11.06)*
Education >12th gradea	1.67 (0.71, 3.89)

Note. OR = odds ratios; CI = confidence interval.

^aReference: immigrant parent.

^bReference: immigrant child.

^cReference: uninsured.

^dReference: not working.

^eReference: unmarried.

^fReference: primary language Spanish.

^gReference: <12th-grade education.

*P < .05.

DISCUSSION

Our study shows that among the 3 groups of Latino children, the child's insurance status, the child's birthplace, and the parents' birthplace profoundly affected the child's access to a regular source of care. Furthermore, US-born children with immigrant parents were more than twice as likely to lack health insurance and access to care as US-born children with US-born parents; immigrant children with immigrant parents were more than 6 times as likely to lack access to health care as US-born children with US-born parents. Thus, Latino children may be missing out on time-sensitive health services because of their own and their parents' place of birth. This result is significant because although most Latino children are US born, many have immigrant parents.10,11

The lower rate of health insurance enrollment found among immigrant parents may be partly attributable to the fact that immigrant parents are more likely than nonimmigrant parents to face noneligibility barriers to enrolling their children. The lower education level of many Latino immigrant parents may place them in low-wage jobs that seldom offer health benefits. This factor may explain a counterintuitive trend we found in our study: Children have poorer access to health insurance and health care when both parents are employed than when only 1 parent is employed.

Given that health insurance is the most important predictor of access to health care, barriers such as birthplace can be overcome if health insurance expansion programs view children in the context of their families and not only as individuals.