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Families caught in the middle

VANCOUVER, BRITISH COLUMBIA When the high cost of health care forces families to forgo paying for basic household expenses, such as rent, utilities or food, children's health suffers, according to research to be presented Sunday, May 2 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Medical care and prescriptions can be costly, even for families with health insurance. However, it is unknown whether health care costs are related to child health.

To explore this question, researchers from Children's HealthWatch, based at Boston Medical Center and Boston University Schools of Medicine and Public Health, interviewed 6,447 low-income caregivers with children ages 0-36 months. Caregivers were asked whether they needed to "trade off" paying for household expenses to obtain medical care, whether they had health insurance and about their child's health history. Children were weighed and measured, and their developmental risk was assessed using the Parents' Evaluation of Developmental Status.

Results showed that 5 percent of caregivers reported making trade-offs to pay for medical care. They most commonly did not pay utility bills (32 percent), rent/mortgage (25 percent) or went without food (21 percent).

Young children in these families, compared to similar families who did not have to make trade-offs, were at increased risk of fair or poor health, hospitalization, developmental delays and shorter stature (an indication of undernutrition), said Stephanie A. Ettinger de Cuba, MPH, lead author of the study and a researcher with Children's HealthWatch.

"Family hardships and high out-of-pocket health care costs are written on the bodies of babies," Ettinger de Cuba said.

Results also indicated that families who did without basic necessities to pay for health care had higher levels of education, and were more likely to be married and breastfeed. Their children also were more likely to be uninsured than children whose families who did not have to make trade-offs.

"This suggests that families who had to make trade-offs are experiencing a paradoxical situation in which caregivers do not earn enough to pay for private insurance for their children, nor do they earn so little that their children can qualify for public insurance, leaving them uninsured and unable to afford both medical costs and basic needs," Ettinger De Cuba said.

Public policies that broaden children's as well as families' access to assistance with health care costs and basic needs may reduce the need for families to choose between essential expenses, thereby improving children's health and development, the researchers concluded.


Contact: Susan Martin
American Academy of Pediatrics

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