Research Spotlight

Squeeze play

By Cindy young
Vital Signs » Summer 2011
Photo of child

One in six parents forgoes pediatrician-recommended care for their insured children because of inability to pay, according to new study

As a pediatrician with a master’s degree in public health, John Pascoe, M.D., is more attuned than most to the difficulties less well-off patients face paying for health care. In the past few years he noticed that more of his privately insured patients were having difficulty paying for the medications and treatments he prescribed, but he didn’t know how extensive the problem was. So he decided to take a closer look.

What he found made national headlines.

Pascoe and his colleagues surveyed 1,978 southwest Ohio parents about the impact of their children’s health insurance on their ability to follow pediatric recommendations, as well as on their child’s health. Pascoe is professor and director of general/community pediatrics at the Boonshoft School of Medicine and a pediatrician at Dayton Children’s Medical Center.

The investigators found that one in six area parents reported that his or her child had not received pediatricianrecommended care—medication, laboratory testing, and/or appointments with specialists—during the previous 12 months due to concerns over cost.

 Pascoe and his colleagues presented their paper, “Parents’ Perspectives on their Children’s Health Insurance: Plight of the Underinsured,” at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco last fall. Coverage of the study appeared in media outlets nationwide, including U.S. Today Online, the Orlando Sentinel, the Baltimore Sun, U.S. News and World Report Online and

Children were considered “underinsured” if their parents had not been able to follow at least one recommendation from a pediatrician during the previous 12 months due to insufficient insurance coverage. Thirty-six percent of parents with underinsured children agreed with the statement that their “child’s health had suffered because of not being able to afford the cost of the needed care,” compared to less than 2 percent of parents who were not underinsured.

“I’ve been practicing medicine for about 30 years, and it just wasn’t like this before,” Pascoe said. “It’s really been in the last five to 10 years when families are being squeezed.”

The study also found that private insurance is a risk factor for underinsurance among families with annual income between $15,000 and $34,999. In addition, children with poorer health were at greater risk of underinsurance compared to healthier children.

“This study has confirmed my sense of how bad it is out there for families,” he said. “The system is squeezing the consumer.”

The investigators speculate the high deductibles and co-pays imposed by private insurance companies are responsible for the high level of child underinsurance among lower-income families whose children do not qualify for public insurance.

“These results serve to highlight a major public health problem pediatricians have observed for years,” said Pascoe. “And many parents believe their children’s health has suffered as a direct result of their inability to afford recommended care for their underinsured children.”

The research was conducted in conjunction with the practices in the Southwestern Ohio Ambulatory Research Network (SOAR-Net), a group of 14 area pediatric practices and clinics that collaborate on research to improve the health and welfare of children and adolescents.

Pascoe hopes the study will alert other pediatricians to the difficulties many insured patients and their families face when paying for medical care. “I hope that my colleagues who may be less sensitive to these issues, will become more sensitive when they read our abstract or paper,” he said. VS

The abstract is posted on the AAP conference web site webprogrampress1010/Paper11071.html Also at

Last edited on 09/22/2015.