Forum on Child and Family StatisticsUsual Source of Health Care
Children's health depends at least partially on their access to health services, including physical examinations, preventive care, health education, observations, screening, immunizations, and sick care.1 Having a usual source of health care—a particular person or place a child goes to for preventive and sick care—facilitates the timely and appropriate use of pediatric services.2 Emergency rooms are excluded here as a usual source of care because their focus on emergency care generally excludes the continuity and types of health services previously mentioned.3
Indicator HC2 Percentage of children ages 0–17 with no usual source of health care by type of health insurance, 2019–2023
NOTE: Children were considered uninsured if they did not have any private health insurance, Medicare, Medicaid, Children's Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or a military plan. Children were also defined as uninsured if they had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. Private health insurance includes children covered by any comprehensive private insurance plan (including health maintenance organizations and preferred provider organizations). These plans include those obtained through an employer, purchased directly, purchased through local or community programs, or purchased through the Health Insurance Marketplace or a state-based exchange. Public health insurance includes children who do not have private coverage but who have Medicaid or other state-sponsored health plans, including CHIP. In 2019, the National Health Interview Survey (NHIS) questionnaire was redesigned, and other changes were made to weighting and design methodology. Starting in 2019, usual source of health care is based on the following question: "Is there a place that [child's name] USUALLY goes when [he is/she is/they are] sick and needs health care?" A follow-up question specified that these places may be a doctor's office or health center, an urgent care center, a clinic in a drug store or grocery store, a hospital emergency room, or some other place. Emergency rooms as a usual source of care were excluded. Due to the changes to the survey design and the specific question on usual source of care, data for 2019 onward are not strictly comparable with data for earlier years. For more information on the 2019 NHIS redesign, see https://www.cdc.gov/nchs/nhis/about/2019-questionnaire-redesign.html.
SOURCE: National Center for Health Statistics, National Health Interview Survey.
- The percentage of children ages 0–17 who had no usual source of health care was stable from 2019 to 2023. While estimates varied from 2% to 3% during this period, differences were not significant.
- From 2019 to 2023, the percentage of children who had no usual source of health care did not significantly change for children in any insurance category.
- Uninsured children are more likely than insured children to lack a usual source of health care. In 2023, 1% of children with private health insurance and 4% of children with public health insurance lacked a usual source of health care. In contrast, 24% of uninsured children lacked a usual source of care—roughly 22 percentage points higher than the rate for privately insured children and 20 percentage points higher than for publicly insured children.4
- In 2023, children in families with incomes below the poverty threshold (6%) were more likely than children in families with incomes at or above 200% of the poverty threshold (2%) to lack a usual source of health care. There was no significant difference between children in families with incomes below the poverty threshold and at 100%–199%
of the poverty threshold or between children in families with incomes at 100%–199% of the poverty threshold and at or above 200% of the poverty threshold.
1 Hagan, J. F., Jr., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
2 Bellettiere, J., Chuang, E., Hughes, S. C., Quintanilla, I., Hofstetter, C. R., & Hovell, M. F. (2017). Association between parental barriers to accessing a usual source of care and children's receipt of preventive services. Public Health Reports, 132(3), 316–325. https://doi.org/10.1177/0033354917699831
3 Cunningham, A., Mautner, D., Ku, B., Scott, K., & LaNoue, M. (2017). Frequent emergency department visitors are frequent primary care visitors and report unmet primary care needs. Journal of Evaluation in Clinical Practice, 23(3), 567–573. https://doi.org/10.1111/jep.12672
4 Although rounded numbers are presented in this indicator, calculations are based on unrounded data.
Federal Interagency Forum on Child and Family Statistics
