Family Structure and Longitudinal Trajectories of Routine Medical and Dental Care Utilization Among Children of Immigrants: The Implication of the ACA and CHIPRA

Background and Purpose:

In spite of major coverage expansions under the Affordable Care Act (ACA) and Children’s Health Insurance Program Reauthorization Act (CHIPRA), a large proportion of immigrant children continue to remain outside the scope of access to health care. Because various provisions of the ACA and CHIPRA seek to enhance access, advancing knowledge about immigrant families’ access to health care is necessary. Evidence has shown that family structure affects children’s utilization of routine health care services, which may have profound implications for children of immigrants—a population whose family interdependence and cohesion are fundamental for child wellbeing in light of challenges associated with immigrant status.  Importantly, the policy changes might be especially critical for children of immigrants in single or cohabiting households over time because vulnerable groups were the explicit target of the legislative changes. However, very little is known about short-term and long-term effects of family structure on the pattern of routine care use among children of immigrants. To this end, this study investigates the longitudinal trajectories of routine medical and dental care use among children of immigrants in different family structures.

Methods:

This study utilizes a nationally representative panel study, the Early Childhood Longitudinal Study, Kindergarten 2010-11 (ECLS-K 2011). The timing of data collection allows the examination of changes in routine care use among children of immigrants as the implementation of these policies was fully realized. Using growth curve modeling, this study estimates differences in initial rates in kindergarten and developmental trajectories of routine medical and dental care use over time through the second grade among first- and second-generation children of immigrants in married-, cohabiting-, and single-parent households compared to children of nonimmigrants. The final sample includes 32,200 observations from 14,350 unique children.

Results:

This study finds that children of immigrants with married parents had most advantage in utilizing routine dental (coefficient=0.044, p<0.001) and medical care (coefficient=0.015, p<0.05) over time despite their lower initial rates of care use (coefficient=-0.167, p<0.0001 and coefficient=-0.023, p<0.05, respectively) compared to children of U.S.-born married parents. Although first-generation children with single parents had lower initial status of dental checkups as well (coefficient=-0.242, p<0.001), their rates of change in care use did not significantly increased over time unlike their counterpart children with married parents.

Conclusions and Implications:

The findings show that family structure plays a critical role in shaping trajectories of routine medical and dental care use among children of immigrants. Although the ACA and CHIPRA expanded benefits to vulnerable populations, these findings may reflect that married-parent families with relatively more familial resources could use those resources to their advantage over time as they may gain familiarity with the U.S. health care system through acculturation and take advantage of a favorable policy climate. These findings can inform program development by directing attention to promoting routine care use among children in single- and cohabiting-parent families through raising awareness of available public health care resources and maximizing the potential of the ACA and CHIPRA to reduce familial, economic, and nativity-based inequality.