Journals > Journal: Critical Health Issues for Children and Youth > Article: The Changing American Family: Implications for Children's Health Insurance Coverage and the Use of Ambulatory Care Services
Journal Issue: Critical Health Issues for Children and Youth Volume 4 Number 3 Winter 1994
Issue Editor's Note
An increasing number of children are being raised by one parent, a divorced or never-married woman (see the Spring 1994 issue of The Future of Children). These families are a heterogeneous group in terms of income, education, employment, and ethnicity or race. Black and Hispanic children are disproportionately represented. This article focuses on one of many important consequences for children of this change in family structure in the United States: the utilization of ambulatory health services by children.
The findings indicate that expansion of private or public insurance coverage will significantly increase the access to and use of preventive and illness-related ambulatory care for uninsured children (see the Summer/Fall 1993 issue of The Future of Children). However, other differences between single- and two-parent families play an important role in impeding children's utilization of health care services and also need to be addressed. Family income has a significant effect on utilization of preventive services even for those with health insurance coverage; out-of-pocket costs and lack of transportation are obstacles. The lower likelihood of illness-related ambulatory visits for children in mother-headed families compared with children in two-parent families is not adequately explained by their lower rates of health insurance coverage or lower incomes. Despite a higher burden of illness in low-income families (see the Winter 1992 issue of The Future of Children) these children are using fewer services. This appears to be a consequence of many cultural, social, behavioral, and health system variables which constitute nonfinancial barriers to service utilization.