The Role of Racial and Ethnic Discrimination in Caregiver Frustration in Child Access to Health Care and Gaps in Insurance Coverage: A 2018 National Survey Study

Background: Studies have documented the impact of family disruption on children’s developmental, mental, and physical health. Little is known about the impact of Adverse Childhood Experiences on caregivers' efforts to secure healthcare for children, especially in the context of racial/ethnic discrimination. The purpose of this paper is to examine the impact of two Childhood Adverse Events (ACEs) ¾ racial/ethnic discrimination and disruption in family life due to caregiver divorce, death, or incarceration, on primary caregiver efforts to access care for their child within and across racial/ethnic groups. Specifically, the study a) describes family disruption and racial discrimination across racial/ethnic groups; b) examines the extent to which experiences of racial discrimination and family disruption are related to caregiver efforts to secure healthcare for their child; and c) conducts sub-group analyses to identify significant factors impacting measured outcomes for each racial/ethnic group.

Methods: The 2018 National Survey of Children’s Health is a nationally representative survey of over 30,000 non-institutionalized children (ages 0-17) and their caregivers. Logistic regressions examined impact of ACEs on two outcomes: caregiver frustration accessing services and child gaps in healthcare coverage. Analyses accounted for the complex survey design and variables correlated with the key independent dependent variables (i.e., child, caregiver, and household factors).

Results: More children of color experienced racial discrimination, compared to Whites (1.0%), with the highest percentages among Blacks (12.6%) and biracial children (9.6%). Compared to Whites (24.7%), Black (41.1%) and Hispanic (30.5%) children experienced higher family disruptions in the past year. All caregivers expressed frustration in accessing services, with highest percentages among bi-racial (17.7%) and Hispanic children (18.6%). Compared to Whites, children of color (excluding Asians) were almost twice as likely to report gaps in health care coverage. The odds of caregiver frustration were 137% higher for children experiencing racial/ethnic discrimination; the odds of having a gap in health care coverage were 29% higher among children experiencing disruption in family life. Sub-group analyses showed that discrimination predicted caregiver frustration among White, Black and Hispanic children (p<0.05); Black children reported the highest magnitude of the effect (OR=3.59; 95% CI=2.08, 6.20).

Conclusions: Racial/ethnic discrimination emerged as a powerful predictor of caregiver frustration accessing services, with Black children greatly impacted. Disruption in family life affected caregiver ability to provide steady coverage. Racial/ethnic disparities in racial discrimination as well as family disruption and their impact on caregivers’ efforts to secure healthcare for their children are expected to be exacerbated as a result of the 2020 COVID-19 pandemic. The effect of these inequities on access to healthcare must be considered when implementing clinical and public health interventions in order to adequately address racial health disparities. This is especially pertinent to health social workers working in these settings to raise awareness and work to create equitable healthcare experiences. Public health policy seeking to address healthcare access inequities must also tackle socio-economic related ACEs impacting children’s lives.