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Abstract: The Texas Children's Hospital Residents' Primary Care Group Clinic provides primary care to urban low-income children. The objective of this cross-sectional study was to investigate the impact of transportation problems on a family's ability to keep an appointment. One hundred eighty-three caregivers of children with an appointment were interviewed. Caregivers who kept their appointment were compared with those who did not with respect to demographic and transportation-related characteristics. Logistic regression modeling predicted caregivers with the following characteristics were more likely not to keep an appointment: not using a car to the last kept appointment, not keeping an appointment in the past due to transportation problems, having more than two people in the household, and not keeping an appointment in the past due to reasons other than transportation problems. Future research should focus on developing interventions to help low-income urban families overcome non-financial access barriers, including transportation problems.
Key words: Transportation, access to health care, child health, urban population.
Despite increases in the numbers of children with health insurance in the United States due to government-sponsored programs such as Medicaid and SCHIP (State Children's Health Insurance Programs), barriers to health care for children still exist. Because of barriers unrelated to health insurance, clinic appointments are not kept, resulting in the disruption of continuity of care and missed opportunities for immunizations, developmental screening, and family/patient education. Patients who do not keep appointments decrease the opportunity for other patients to receive timely care and contribute to rising health care costs by reducing practice revenue and causing poor utilization of resources.1
While Medicaid does improve access to health care for poor children, it does not ensure that they have access to the same locations of health care and the same continuity of care as children in higher-income families. St. Peter and colleagues found that, when compared with children not living in poverty, poor children were less likely to have a usual source of well-child or sick care and were less likely to obtain care in a private pediatrician's office.2 They found that poor children with Medicaid coverage were just as likely as poor children without Medicaid coverage to have a usual source of routine care different than their usual source of sick care. Poor children with Medicaid...