Hanes M Swingle1, Ralph Wilmoth, Mary L Aquilino. 1. Department of Pediatrics, University of South Alabama, 1700 Center Street, Mobile, AL 36604-3273, USA. hswingle@usouthal.edu
Abstract
BACKGROUND: In Iowa 70.7% of children who qualify for Title XIX and/or Title V services have a medical home, but in Johnson County, Iowa only 54.0% of such children have one. Objectives Identify barriers to access to a medical home for children who use Johnson County Public Health (JCPH) services and recommend strategies to overcome these barriers. METHODS: Families with children attending JCPH well-child and WIC clinics were randomly selected to be interviewed using a semi-structured, 38-item questionnaire. Data analysis used qualitative and quantitative methodologies. RESULTS: Among 71 families interviewed, 41 had children without a medical home and 85% of these families cited financial barriers. Lack of U.S. citizenship accounted for 59% without health insurance. A recent move contributed to 29% not having medical homes. Nine different languages were spoken among the 41 families without a medical home. Forty-one percent of all parents interviewed had never had a medical home themselves. Many parents perceived emergency departments as more convenient than doctors' offices. CONCLUSIONS: Lack of health insurance, due primarily to citizenship status, is the greatest barrier to access to a medical home in this population. The migratory nature of the U.S. population, marked cultural diversity, and parental attitudes were additional barriers to children's access to a medical home. Strategies to overcome these barriers are discussed.
BACKGROUND: In Iowa 70.7% of children who qualify for Title XIX and/or Title V services have a medical home, but in Johnson County, Iowa only 54.0% of such children have one. Objectives Identify barriers to access to a medical home for children who use Johnson County Public Health (JCPH) services and recommend strategies to overcome these barriers. METHODS: Families with children attending JCPH well-child and WIC clinics were randomly selected to be interviewed using a semi-structured, 38-item questionnaire. Data analysis used qualitative and quantitative methodologies. RESULTS: Among 71 families interviewed, 41 had children without a medical home and 85% of these families cited financial barriers. Lack of U.S. citizenship accounted for 59% without health insurance. A recent move contributed to 29% not having medical homes. Nine different languages were spoken among the 41 families without a medical home. Forty-one percent of all parents interviewed had never had a medical home themselves. Many parents perceived emergency departments as more convenient than doctors' offices. CONCLUSIONS: Lack of health insurance, due primarily to citizenship status, is the greatest barrier to access to a medical home in this population. The migratory nature of the U.S. population, marked cultural diversity, and parental attitudes were additional barriers to children's access to a medical home. Strategies to overcome these barriers are discussed.
Authors: P W Newacheck; B Strickland; J P Shonkoff; J M Perrin; M McPherson; M McManus; C Lauver; H Fox; P Arango Journal: Pediatrics Date: 1998-07 Impact factor: 7.124
Authors: Judith S Palfrey; Lisa A Sofis; Emily J Davidson; Jihong Liu; Linda Freeman; Michael L Ganz Journal: Pediatrics Date: 2004-05 Impact factor: 7.124