Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Weathers, Andrea C., Scott P. Novak, Narayan Sastry, and Edward Norton. 2008. "Parental nativity is an important factor associated with where children usually go for health care." Maternal and Child Health Journal, 12(4): 499-508.
Purpose Few studies of children's access to care account for the independent effects of parental immigration characteristics. To address this gap in knowledge, we examine the association between parental nativity and where children usually obtain health care. Data source The 2002 National Survey of America's Families (N = 34,332). Results Fourteen percent of the sampled children had only foreign-born parents. Most of the sampled children used physician's offices or HMOs (69%) and clinics or other hospital outpatient settings (24%) as usual sites for health care; few used hospital emergency departments or other care providers (1.4%). After adjusting for confounders, using multinomial logistic regression, both citizen [OR = 1.92 (1.44-2.56)] and non-citizen [OR = 5.21 (3.33-8.15)] children with foreign-born parents were more likely to lack a usual site for health care, compared to children with at least one US-born parent-regardless of the mother's citizenship and duration of stay in the US. After accounting for parental nativity, lack of citizenship and shorter durations of US stay among mothers were associated with children's greater use of public clinics or other hospital outpatient settings, rather than physician's offices or HMOs. The effect of parental nativity persisted for minority, but not white, children; however, non-citizen children lacked a usual site for health care regardless of their race and ethnicity. Conclusion The immigration characteristics of parents are important to disparities in where children usually go for health care. These results suggest that increasing the "biomedical acculturation" of immigrant mothers may improve access to care for their children.