Child health insurance and early preventive care in three South American countries.

Not much is known about how health insurance affects preventive care for children who have access to general routine paediatric care, especially in less developed settings. This study evaluates the effects of child health insurance on preventive care (measured by whether the child had received all the age-appropriate immunizations) for children with access to routine paediatric care. It uses a unique sample of 1958 children aged 3-24 months attending paediatric practices for routine well-child care in Argentina, Brazil and Ecuador. It compares insured and uninsured children attending the same paediatric clinics for routine care at the time of enrolment into the study and only uses within-clinic variation in insurance status when evaluating its effect on immunization status. Regression models for adequate immunization status adjust for several demographic, socio-economic and health characteristics and are estimated both separately for each country and combining the three countries. The majority of children in the study sample have received all age-appropriate immunizations. However, publicly insured children in Argentina and Ecuador are more likely to have received all age-appropriate immunizations compared with uninsured children by 3.5 and 2.3 percentage points, respectively. In the model that combines the three country samples, insured children (regardless of insurance type) are significantly more likely to have adequate immunization status by 2.5 percentage points compared with uninsured children. The study provides evidence that health insurance may enhance preventive care for young children.