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America's Children: Key National Indicators of Well-Being, 2019

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.49 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.50, 51 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.52

HC2: Percentage of children ages 0–17 with no usual source of health care by type of health insurance, 1993–2017
Indicator HC2: Percentage of children ages 0–17 with no usual source of health care by type of health insurance, 1993–2017

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. Usual source of health care is 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 specifies that these places may be a walk-in clinic, doctor's office, clinic, health center, health maintenance organization, outpatient clinic, or military or Veterans Administration health care facility. Emergency rooms are excluded as a usual source of care. A break is shown in the lines because in 1997 the National Health Interview Survey was redesigned. Data for 1997–2017 are not strictly comparable with earlier data.

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

  • In 2017, about 4% of children ages 0–17 had no usual source of health care.
  • The percentage of children with private or public (including Medicaid) insurance who had no usual source of health care declined from 1993 to 2017. In contrast, there was no statistically significant difference in the percentage of uninsured children without a usual source of health care in 2017 (27%) compared with 1993 (24%).
  • Uninsured children are much more likely to have no usual source of health care than children who have health insurance. In 2017, 27% of children who were uninsured had no usual source of health care, which was 25 percentage points higher than the percentage of children with private health insurance who had no usual source of health care (2%) and 23 percentage points higher than the percentage of children with public health insurance who had no usual source of health care (4%).
  • In 2017, older children were more likely than younger children to lack a usual source of health care among those with no health insurance (30% versus 17%). There was no statistically significant difference in the percentage of older and younger children without a usual source of health care for children with private or public insurance in 2017.

table icon HC2 HTML Table

49 Green, M. (Ed.). (1994). Bright futures: Guidelines for health supervision of infants, children, and adolescents. Arlington, VA: National Center for Education in Maternal and Child Health.

50 Simpson, G., Bloom, B., Cohen, R. A., & Parsons, P. E. (1997). Access to health care. Part 1: Children. Vital and Health Statistics, 10 (Series 196). Hyattsville, MD: National Center for Health Statistics.

51 Bartman, B. A., Moy, E., & D'Angelo, L. J. (1997). Access to ambulatory care for adolescents: The role of a usual source of care. Journal of Health Care for the Poor and Underserved, 8, 214–226.

52 Folton, G. L. (1995). Critical issues in urban emergency medical services for children. Pediatrics, 96 (2), 174–179.