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America's Children: Key National Indicators of Well-Being, 2021

Usual Source of Health Care

Children's health depends at least partially on their access to health services. Health care for children includes physical examinations, preventive care, health education, observations, screening, immunizations, and sick care.46 Having a usual source of health care—a particular person or place a child goes to for sick and preventive care—facilitates the timely and appropriate use of pediatric services.47 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 care mentioned earlier.48

HC2: Percentage of children ages 0–17 with no usual source of health care by type of health insurance, 2019
Indicator HC2: Percentage of children ages 0–17 with no usual source of health care by type of health insurance, 2019

NOTE: A child was considered uninsured if he or she 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. A child was also defined as uninsured if he or she 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. Before 2019, usual source of health care was based on the following question: "Is there a place that [child's name] USUALLY goes when [he/she] is sick or needs advice about [his/her] health?" A follow-up question specified that these places may be a doctor's office or health maintenance organization, a clinic or health center, a hospital outpatient department, or some other place. Emergency rooms were not considered a usual source of health care. 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 hospital emergency room is now considered a usual source of health care and urgent care center has been added as a usual source of health care. Due to the changes to the survey design and the specific question on usual source of care, data for 2019 are not strictly comparable with data for earlier years. For more information on the 2019 NHIS redesign, see https://www.cdc.gov/nchs/data/nhis/earlyrelease/EReval202009-508.pdf.

SOURCE: National Center for Health Statistics, National Health Interview Survey.

  • In 2019, about 3% of children ages 0–17 had no usual source of health care.
  • Uninsured children are more likely to lack a usual source of health care compared with children who have health insurance. In 2019, 18% of children who were uninsured had no usual source of health care, which was 16 percentage points higher than the percentage of children with private health insurance who had no usual source of health care (2%) and 15 percentage points higher than the percentage of children with public health insurance who had no usual source of health care (3%).
  • Children in families with incomes below poverty or at 100%–199% of the poverty level were more likely to lack a usual source of care (4% each) compared with children in families with incomes at 200% poverty and above (2%) in 2019.

table icon HC2 HTML Table

46 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.

47 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.

48 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.