Health insurance and health-care utilization of U.S.-born Mexican-American children *.

Objectives. We document and model health insurance coverage and health-care utilization of very young, U.S.-born Mexican-American children relative to their non-Hispanic white and black counterparts. Methods. We use data from the Fragile Families and Child Wellbeing Study and multivariate regression methods. Results. Based on descriptive and multivariate analyses, the findings show that compared to non-Hispanic white children, Mexican-American children have lower rates of health insurance coverage and less health-care utilization. Mexican-American children born in the United States to foreign-born mothers utilize health care the least and are much more likely to be fully uninsured compared to other children. Conclusion. The early health advantage of Mexican-origin children at birth runs the risk of being compromised by the time they reach age three as a result of poor access to healthcare. Greater health insurance coverage for Mexican-American children and, in particular, Mexican-American children of immigrants is needed.

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Despite extensive research attention to the relatively favorable birth outcomes of Mexican-American infants, a pattern of research findings called the epidemiologic paradox because of Mexican Americans' relatively disadvantaged socioeconomic status in the United States (Markides and Coreil, 1986; Frisbie, Forbes, and Hummer, 1998), little is known about Mexican-American child health outcomes (Guendelman, 1998). Some research indicates that Mexican-American children, especially U.S.-born Mexican-American children, may not show the same relative health advantage evidenced at birth (Guendelman, English, and Chavez, 1995; Flores et al., 1999; Padilla et al., 2002). Given that race and ethnicity influence health through a variety of socioeconomic conditions and proximate determinants, one of which is access to healthcare (Mosley and Chen, 1984; Hummer, 1996), understanding racial/ethnic differences in children's access to and utilization of healthcare is a crucial part of understanding Mexican-American child health.

Huge disparities in child health insurance coverage and health-care utilization exist between racial/ethnic groups in the United States. Hispanic children are the least likely to have health insurance coverage (DeNavas-Walt, Proctor, and Lee, 2005) and, among Hispanics, Mexican-American children are most likely to be uninsured, lack a regular source of heathcare, and have unmet medical needs due to cost (Scott and Ni, 2004). Among Mexican-American children, health insurance coverage and health-care access and utilization vary dramatically by nativity and generation, with the lowest rates among first-generation (i.e., foreign-born) Mexican-American children (Burgos et al., 2005).

We extend prior work in this area by analyzing the health insurance coverage and health-care utilization of U.S.-born Mexican-Americans in early childhood. Specifically, we conduct a comparative analysis of second- and third-plus generation (1) Mexican-American children and non-Hispanic white and non-Hispanic black children at age three drawn from a national sample of births in urban hospitals in the late 1990s. We then present regression models that take into account demographic, health, and socioeconomic factors to best determine if the health insurance and health-care utilization differences in question are, at least in part, brought about by differences in infant health and the resource differentials across racial/ethnic groups.

Review of Recent Literature

Reporting the health insurance coverage and health-care utilization of Mexican-American children in comparison to other racial/ethnic groups in the United States is a crucial step toward disentangling the child health profile of Mexican Americans, the largest Hispanic subgroup and one of the most rapidly growing populations in the United States (Saenz, 2004). Much of the research focus for Mexican Americans has been on the epidemiologic paradox, a term that was coined to describe a set of research findings that consistently show that Mexican-American infants have rates of low birth weight and other compromised birth outcomes that are similar to non-Hispanic white infants (Markides and Coreil, 1986; Frisbie, Forbes, and Hummer, 1998; Frisbie et al., 1997; Mendoza et al., 1991). The relative good health of Mexican-American infants is paradoxical in light of the generally disadvantaged socioeconomic position that Mexican Americans, as a group, hold in U.S. society (Bean and Tienda, 1987; Saenz, 2004). However, the research attention and debate surrounding the epidemiologic paradox has tended to overshadow research interest in and attention to other Hispanic health issues (Zambrana and Logie, 2000), specifically subsequent Mexican-American child health (Guendelman, 1998). Indeed, studies have shown that in comparison to children in other major U.S. racial/ethnic groups, Mexican-American children have high rates of infectious disease (Guendelman, English, and Chavez, 1995), poor parent-reported health (Flores et al., 1999), and less-well-developed language skills (Padilla et al., 2002).

Poor health outcomes among Mexican-American children are not paradoxical given evidence that shows that both Mexican-American adults and children are disadvantaged in terms of health insurance coverage, access to healthcare, and utilization of healthcare. Analyses of various sources of national data show that Hispanic children have the lowest rates of health insurance coverage of all major U.S. racial/ethnic groups (DeNavas-Walt, Proctor, and Lee, 2005:17-19). Among Hispanics, Mexican-American children are most likely to be uninsured (Scott and Ni, 2004; Huang, 1997). They are the most likely to lack a regular source of healthcare and have unmet medical needs due to cost (Scott and Ni, 2004). They also have the fewest physician visits and are the most likely to not have seen a doctor within the past year (Flores et al., 1999).

Most studies in the area have not been able to separate Mexican-American children by nativity and generation, an important distinction given the heterogeneity of the Mexican-American population (Bean and Tienda, 1987; Saenz, 2006), and some research that shows that health tends to deteriorate among immigrant groups across time and generational status in the United States (Landale, Oropesa, and Gorman, 2000; Lopez-Gonzalez, Aravena, and Hummer, 2005; National Research Council, 1998). Burgos et al. (2005) recently helped fill this gap by showing that first-generation Mexican-American children (i.e., foreign-born children) aged 0-16 were, by far, the most likely subset of Mexican-American children to be uninsured, to lack a regular source of care, and to not have seen a doctor in the past year. Burgos and colleagues show (2005:Table 1) that an astonishing percentage (64.2 percent) of first-generation Mexican-American children lack any kind of health insurance coverage at all; second- and third-generation Mexican-American children are covered at higher rates but still have substantially higher rates of noncoverage compared to non-Hispanic black and white children (25.4 and 15.9 percent of second- and third-generation Mexican Americans are uncovered, respectively, vs. 10 and 7.5 percent of black and white children, respectively). In their analysis of access to care, the authors find that, net of health insurance differences across groups, there are no significant differences between second- and third-generation Mexican Americans and white children in terms of having a usual source of care or having seen a doctor in the past year. Thus, access differences between second- and third-generation Mexican-American children and whites could be largely rooted in health insurance differences across these groups.

We build on this important prior work in …