The ecology of medical care for children in the United States

Susan Dovey, Michael Weitzman, George Fryer, Larry Green, Barbara Yawn, David Lanier, Robert Phillips

Research output: Contribution to journalArticle

Abstract

Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13-17 years) and poverty status were associated with hospitalization (P < .05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. Conclusions. The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.

Original languageEnglish (US)
Pages (from-to)1024-1029
Number of pages6
JournalPediatrics
Volume111
Issue number5 I
DOIs
StatePublished - May 1 2003

Fingerprint

Child Care
Ecology
Poverty
Dentists
Delivery of Health Care
Physicians' Offices
Insurance Coverage
Health Insurance
Hospital Emergency Service
Hospital Outpatient Clinics
Sex Factors
Age Factors
Health Expenditures
Hispanic Americans
Health Status
Hospitalization
Outpatients
Multivariate Analysis
Parents
Education

Keywords

  • Ecology
  • Health systems
  • Medical care
  • Medical Expenditure Panel Survey
  • Primary care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Dovey, S., Weitzman, M., Fryer, G., Green, L., Yawn, B., Lanier, D., & Phillips, R. (2003). The ecology of medical care for children in the United States. Pediatrics, 111(5 I), 1024-1029. https://doi.org/10.1542/peds.111.5.1024

The ecology of medical care for children in the United States. / Dovey, Susan; Weitzman, Michael; Fryer, George; Green, Larry; Yawn, Barbara; Lanier, David; Phillips, Robert.

In: Pediatrics, Vol. 111, No. 5 I, 01.05.2003, p. 1024-1029.

Research output: Contribution to journalArticle

Dovey, S, Weitzman, M, Fryer, G, Green, L, Yawn, B, Lanier, D & Phillips, R 2003, 'The ecology of medical care for children in the United States', Pediatrics, vol. 111, no. 5 I, pp. 1024-1029. https://doi.org/10.1542/peds.111.5.1024
Dovey S, Weitzman M, Fryer G, Green L, Yawn B, Lanier D et al. The ecology of medical care for children in the United States. Pediatrics. 2003 May 1;111(5 I):1024-1029. https://doi.org/10.1542/peds.111.5.1024
Dovey, Susan ; Weitzman, Michael ; Fryer, George ; Green, Larry ; Yawn, Barbara ; Lanier, David ; Phillips, Robert. / The ecology of medical care for children in the United States. In: Pediatrics. 2003 ; Vol. 111, No. 5 I. pp. 1024-1029.
@article{0eafe66fe011400fb501c4ce2e1c6a43,
title = "The ecology of medical care for children in the United States",
abstract = "Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13-17 years) and poverty status were associated with hospitalization (P < .05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. Conclusions. The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.",
keywords = "Ecology, Health systems, Medical care, Medical Expenditure Panel Survey, Primary care",
author = "Susan Dovey and Michael Weitzman and George Fryer and Larry Green and Barbara Yawn and David Lanier and Robert Phillips",
year = "2003",
month = "5",
day = "1",
doi = "10.1542/peds.111.5.1024",
language = "English (US)",
volume = "111",
pages = "1024--1029",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "5 I",

}

TY - JOUR

T1 - The ecology of medical care for children in the United States

AU - Dovey, Susan

AU - Weitzman, Michael

AU - Fryer, George

AU - Green, Larry

AU - Yawn, Barbara

AU - Lanier, David

AU - Phillips, Robert

PY - 2003/5/1

Y1 - 2003/5/1

N2 - Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13-17 years) and poverty status were associated with hospitalization (P < .05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. Conclusions. The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.

AB - Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13-17 years) and poverty status were associated with hospitalization (P < .05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. Conclusions. The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.

KW - Ecology

KW - Health systems

KW - Medical care

KW - Medical Expenditure Panel Survey

KW - Primary care

UR - http://www.scopus.com/inward/record.url?scp=0037967174&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037967174&partnerID=8YFLogxK

U2 - 10.1542/peds.111.5.1024

DO - 10.1542/peds.111.5.1024

M3 - Article

C2 - 12728083

AN - SCOPUS:0037967174

VL - 111

SP - 1024

EP - 1029

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 5 I

ER -