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Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 4/2014

01-05-2014

Child Health Insurance Coverage and Household Activity Toward Child Development in Four South American Countries

Author: George L. Wehby

Published in: Maternal and Child Health Journal | Issue 4/2014

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Abstract

We evaluate the association between child health insurance coverage and household activities that enhance child development. We use micro-level data on a unique sample of 2,370 children from four South American countries. Data were collected by physicians via in-person interviews with the mothers. The regression models compare insured and uninsured children seen within the same pediatric care practice for routine well-child care and adjust for several demographic and socioeconomic characteristics. We also stratify these analyses by selective household demographic and socioeconomic characteristics and by country. We find that insurance coverage is associated with increasingly engaging the child in development-enhancing household activity in the total sample. This association significantly varies with ethnic ancestry and is more pronounced for children of Native or African ancestry. When stratifying by country, a significant positive association is observed for Argentina, with two other countries having positive but insignificant associations. The results suggest that insurance coverage is associated with enhanced household activity toward child development. However, other data and research are needed to estimate the causal relationship.
Appendix
Available only for authorised users
Footnotes
1
The children may have received interventions from the pediatricians as part of the routine pediatric care. The definition of routine care was broad in the parent study and included seeking care for no specific health problems—only for the regular recommended well-child evaluations. We have no data on the content and intensity of the provided pediatric care and on other aspects of provider behavior (such as extent of providing information to parents and counseling them about child development and household activity) and how such factors may have varied between insured and uninsured children. The parent study collected data only on child development and household characteristics.
 
2
Note that country fixed effects cannot be included in the model once clinic fixed effects are included.
 
3
These indicators include: ownership of radio, TV, fridge and car; having a domestic worker in the household; working on family’s agricultural land; source of drinking water; type of toilet/sewage facility; type of house flooring; type of wall material; type of roofing material; and number of household members per sleeping room. Self-reported income and household expenditures are not measured in this study as they are generally considered unreliable in less developed settings due to interrupted income flows and lack of data on prices.
 
4
Table 5 in the “Appendix” reports the full OLS regression results for the total sample.
 
5
As mentioned above, the activity index has a mean of 0 and a standard deviation of ~1 and ranges from −1.45 to +2.41. Furthermore, the variation in this index represents over 50 % of the variation in the frequency of the three household activities. For easier interpretation, the magnitude of the regression coefficient has to be considered relative to the standard deviation and the range of the index. In order to further facilitate the interpretation of the magnitude of the association between insurance status and the household activity index, we show the sample distribution of the activity frequencies for insured and uninsured children in “Table 6” in the “Appendix”. These differences are unadjusted for the model covariates. The magnitude of the insurance coefficient in the unadjusted regression for the activity index is about twice as large as that in the adjusted model (0.42 vs. 0.19). Therefore, one could generally interpret the magnitude of the adjusted association between insurance and the activity index to be close to half of the unadjusted difference in the activity frequencies between insured and uninsured children.
 
6
Table 4 shows the regressions using the household activity index generated for the total sample. However, we repeat these regressions using activity indices generated separately for each country and observe virtually similar results.
 
7
The regression coefficient of insurance in this model is 0.196 (p = 0.018).
 
8
The coefficients of insurance in these regressions cannot be rejected from being equal to 0 at p > 0.7.
 
9
Theoretically speaking, a causal effect may result from increased parental information about optimal household activity for child development due to greater access to well-child care and more frequent visits to pediatricians who may counsel parents about such activity or through awareness-raising programs provided by insurance plans. Even though our study compared insured and uninsured children who were visiting the same pediatric clinic for well-child care at the time of enrollment into the study and data collection, insured children in our sample may have obtained more routine well-child care visits than uninsured ones before their enrollment, which cannot be captured in the study, as we have no data on prior use of pediatric care.
 
10
The data are not weighted by sampling probability weights as these weights are not available given that the study is based on a convenience sample. Each observation has the same weight in the analysis.
 
11
This underestimation may occur if healthcare professionals provide more counseling to parents of children at greater risk of developmental problems about household activities to reduce this risk.
 
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Metadata
Title
Child Health Insurance Coverage and Household Activity Toward Child Development in Four South American Countries
Author
George L. Wehby
Publication date
01-05-2014
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 4/2014
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-013-1321-y

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