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Public Health Rep. 2009 Sep-Oct;124(5):682-91.

Improvements in access to care for vulnerable children in California between 2001 and 2005.

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Department of Family Medicine, University of Southern California Keck School of Medicine, Alhambra, CA 91803, USA.



We examined population changes in access to care for children in California during a period of major efforts to improve access to care for children.


We used cross-sectional data on 36,010 children aged 0-19 years from the 2001 and 2005 California Health Interview Survey to assess population changes in access to care. We assessed changes in access by individual risk factors and a composite risk profile.


In 2005, a smaller proportion of children were uninsured (8.2% vs. 10.9% in 2001), living in poverty (20.7% vs. 23.2% in 2001), and in families without a high school education (20.8% vs. 23.6% in 2001), all p<0.001. Before and after adjusting for these changes in risk, children were more likely in 2005 to have had a physician visit (odds ratio [OR] = 1.09, 95% confidence interval [CI] 1.07, 1.12) and dental visit (OR=1.11, 95% CI 1.08, 1.14). Children were slightly less likely in 2005 to have a regular source of care (OR=0.94, CI 0.91, 0.96). Children who had the highest risk profiles (> or = 4 risk factors) experienced the largest gains in access. For example, children with three and > or = 4 risk factors had gains in dental visits of 11 and 20 percentage points, respectively (p<0.001 for each), compared with < or = 3 percentage points for children with fewer risk factors.


This study found improvements in physician and dental visits between 2001 and 2005 that were not fully explained by changes in insurance coverage or other demographic risk factors. Vulnerable children fared well during this period, suggesting that California may be making important and potentially replicable strides in reducing disparities.

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