Statistical Brief #3:

CHILDREN’S HEALTH CARE QUALITY, Fall 2000

The quality of the health care received by children in America is an issue of public policy

concern for several reasons. First, the level of quality of the health care delivery system

affects the capacity to provide timely, accessible, effective and efficient medical care to

children in need of services. In addition, all children may not be receiving care equally.

Following these subgroups of children over time can provide information about whether

greater equity has been achieved or whether serious gaps remain. In 2000, a parentadministered questionnaire was added to the Medical Expenditure Panel Survey (MEPS)

to collect a variety of health status and health care quality measures of children. The

health care quality measures for this study were taken from the health plan version of

CAHPS®, an AHRQ sponsored family of survey instruments designed to measure quality

of care from the consumer’s perspective. The questionnaire was administered in late

2000 and early 2001. All of the questions refer to events experienced in the last 12

months. This MEPS Statistical Brief presents preliminary analyses of what parents report

about the quality of their children’s medical care based on the 2000 MEPS parentadministered questionnaire.

HIGHLIGHTS

Access to Care

Needing care right away and getting it as soon as wanted

Overall, 39.0 percent of children under age 18 (27.8 million children in the U.S. civilian

noninstitutionalized population) were reported to have had an illness or injury that needed

care right away from a doctor’s office, clinic, or emergency room (figure 1A). Parents

reported that nearly two-thirds (63.7 %) of children needing care right away because of

an illness or injury always received care as soon as it was wanted (figure 1B). Receiving

needed medical care right away was more likely to present a difficulty for the following

groups: children who were uninsured or had only public health insurance. Among those

needing care right away, uninsured children or those with public-only coverage were less

likely to always receive the care as soon as their parents wanted relative to those with

private coverage (52.1 % for uninsured children, 58.4% for children with public-only

insurance, 66.6 % for privately insured children). For older children ages 6-17, the

uninsured were noticeably less likely to always receive care for illness or injury as soon

as their parents wanted relative to those with public-only or private coverage (41.9 % for

uninsured older children, 56.1% for public-only insured older children, 64.9 % for

privately insured older children) (figure 1C).

Getting a routine appointment as soon as wanted

Overall, 70.3 percent of children under age 18 (50.1 million children in the U.S. civilian

noninstitutionalized population) were reported to have appointments made with a doctor

or other health provider for regular or routine care in the last 12 months (figure 2A). For
those children with appointments, only about half (52.1 %) had parents reporting always

obtaining one as soon as it was wanted (figure 2B). Obtaining appointments for routine

care was more likely to present a difficulty for Hispanic children and those without health

insurance. Of those reporting an appointment for routine care, Hispanic children were

less likely than white or black children to have always received appointments as soon as

their parents wanted (45.0 % of Hispanic children, 53.7 % of white children, and 53.8 %

of black children). This pattern between Hispanic and white children was more

pronounced for younger children aged 5 and under (46.8% of younger Hispanic children,

58.2% of younger white children, not shown in figures). Uninsured children were less

likely than those with private coverage to have always received appointments as soon as

their parents wanted (42.4 % of uninsured children, 54.2% for children with private

coverage) (figure 2C). This pattern held for younger children aged 5 and under (42.3%

younger uninsured children, 58.7% for younger children with private coverage, not

shown in figures).

Problems receiving needed care

Overall, 78.0 percent of children under age 18 (55.6 million children in the U.S. civilian

noninstitutionalized population) were reported to have one or more visits to a doctor’s

office or clinic in the last 12 months (figure 3A). Among those children receiving care,

88.6 percent reported not having problems receiving care their parents or doctors

believed necessary (figure 3B). Getting needed care was more likely to be reported as

presenting a problem for black and Hispanic children relative to white children (percent

reporting no problem: 83.2 % of Hispanic children, 85.2 % of black children, 91.0 % of

white children). This differential pattern by race/ethnicity was consistent for children

ages 5 and under as well as for children ages 6-17. In addition, uninsured children or

those with public-only coverage were more likely to have their parents report problems

receiving needed care relative to those with private coverage (percent reporting no

problem: 84.2% for uninsured children; 79.6 % for children with public-only coverage,

92.1 % for privately insured children) (figure 3C). The greater difficulty in getting

needed care for uninsured children or children with public-only insurance was evident in

both younger and older aged children.

Problems in getting a referral to a specialist

Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and

others who specialize in one area of health care. Overall, 18.1 percent of children under

age 18 (12.9 million children in the U.S. civilian non-institutionalized population) needed

to see a specialist in the last 12 months (figure 4A). Many health insurance plans require

a referral from a primary care provider before a specialist can be seen. Of those children

needing to see a specialist, getting a referral was reported as not a problem for more than

three-fourths (77.5 percent) of children (figure 4B). Getting a referral was more likely to

present a difficulty for children with only public health insurance than for children with

private insurance (percent reporting no problem: 66.6 % of children with public-only

coverage, 81.2 % of children with private coverage). This pattern was more pronounced
for older children ages 6-17 (62.7% of children with public-only insurance, 82.1% of

children with private coverage, not shown in figures).

Experiences During Care

Parents were asked to report on their experiences over the last 12 months during visits to

a doctor’s office or clinic to get care for their children. They were asked how often during

these child care visits the health providers listened carefully to them, explained things in

a way they could understand, and showed respect for what they had to say. They were

also asked how often the health provider spent enough time with them and their children

during these child care visits. Only parents of children who made one or more visits to a

doctor’s office or clinic in the last 12 months responded to the items presented below.

Health providers listening carefully to parents:

Overall, 65.5 percent of parents reported that their children’s health providers always

listened carefully to them or their children (65.5% always, 28.1% usually, 6.5%

sometimes/never) (figure 5A). Hispanic children were the least likely to have their

parents report that their providers always listened carefully to them (59.4% of Hispanic

children, 65.9 % of white children, and 72.5 % of black children). Uninsured children

were less likely than children with private insurance to have their parents report that their

providers always listened carefully to them (57.1% of uninsured children, 67.2% of

privately insured children) (figure 5B). This observed differential was more pronounced

for children aged 5 and under.

Health providers explaining things so parents understand:

Over two-thirds (68.4 percent) of all children were reported to have health providers who

always explained things in a way their parents could understand (68.4% always, 25.9 %

usually, 5.7 % sometimes/never) (figure 6A). Hispanic children were less likely than

white or black children to have their parents report that their providers always explained

things in a way they could understand (62.0% of Hispanic children, 69.1 % of white

children, and 74.3 % of black children). In addition, uninsured children (61.6%) and

children with public-only insurance (63.7%) were less likely to have providers who always

explained things in a way that could be understood than children with private insurance

(70.9 %) (figure 6B).

Health providers showing respect to what parents say:

Over two-thirds (67.3 percent) of all children were reported to have health providers who

always showed respect for what their parents had to say (67.3% always, 26.3% usually,

6.3% sometimes/never) (figure 7A). Hispanic and white children were less likely than

black children to have their parents report that their providers always showed respect for

what they had to say (63.7 % of Hispanic children, 66.9% of white children, 75.4% of

black children). In addition, uninsured children were less likely than privately insured

children or children with public-only insurance to have their parents report that their

providers always showed respect for what they had to say (58.7 % of uninsured children,

64.9 % of children with public-only insurance, 69.3 % of children with private insurance)

(figure 7B).
Health providers spending enough time with parents and the patients:

Over half (56.1 percent) of all children were reported to have health providers who

always spent enough time with them and their parents (56.1% always, 33.5 % usually,

10.4 % sometimes/never) (figure 8A). Hispanic children were less likely than black

children to have their parents indicate their providers always spent enough time with

them (51.9% of Hispanic children, 61.8 % of black children). In addition, uninsured

children were less likely than those with private coverage to have their parents report that

their providers always spent enough time with them (49.5 % of uninsured children, 57.5

% of children with private coverage) (figure 8B).

About MEPS and CAHPS

This statistical Brief summarizes access and quality of care measures pertaining to the

health care received by noninstitutionalized children of the United States. The Medical

Expenditure Panel Survey (MEPS) collects nationally representative data on health care

use, expenditures, sources of payment, insurance coverage and the quality of care for the

U.S. civilian noninstitutionalized population. MEPS is sponsored by the Agency for

Healthcare Research and Quality (AHRQ). The health care quality measures used for this

study were taken from the health plan version of CAHPS®, an AHRQ sponsored family

of survey instruments designed to measure quality of care from the consumer’s

perspective. A conditional response rate of 90 percent was achieved for the MEPS parentadministered questionnaire, yielding an overall response rate of 63 percent for the survey

(6,577 respondents to the Parent Administered Questionnaire (PAQ)). Specific item

nonresponse rates generally varied from 0.5 to 7.0 percent for the study questions. The

results presented in this Statistical Brief are statistically significant at the .05 level.

Additional analyses that consider more detailed age classifications for these measures

will be forthcoming. More information about MEPS can be obtained through the MEPS

website at www.meps.ahrq.gov. More information about CAHPS can be obtained

through the CAHPS website (www.cahps.ahrq.gov) or on the AHRQ website

(www.ahrq.gov).
Figure 1 Figure 1A

Percent Percent of children < 18 who needed care right away from a 

doctor's office, clinic, or emergency room in the last 12

months, b nths, by insurance status rance status

39.0 47.9

34.7

43.1 52.3

35.0 25.7 42.0 40.3 39.3 30.1

18.7

0

20

40

60

80

100

All children Under age 6 Ages 6-17

Perc

e

nt

Total Any private Public only Uninsured

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 1B Figure 1B

Among children < 18 who neededcare right away in the last

12 months, percent distribution of getting care getting care for an

illness/injury as soon as wanted by insurance status

52.1

33.3

63.7 66.6

58.4

26.1

25.0

27.0

10.2 8.4 14.6 14.6

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 1C

Among older children ages 6-17 who needed care r needed care right away in

the last 12 months, percent dist ent distribution of getting care for an 

illness/injury as soon a as soon as wanted by nted by insurance stat surance status

41.9

61.6 64.9

56.1

27.7 26.6 27.3 39.8 18.3

10.6 8.6 16.5

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 2 Figure 2A

Percent Percent of children < 18 who had appointments for regular or

routine health care with a doctor or otherhealth prov alth provider in th der in the 

last 12 months, by race/ethni ace/ethnicity

74.3

58.9

70.3

62.9

64.8

0

20

40

60

80

100

Total Hispanic Black White Other

Perc

e

nt Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 2B

Among chil ong children < 18 dren < 18 who had appointm appointments for regul r regular or

routine healt ine health care inthe last he last 12 months, months, percent distribution of

getting them as soon a as soon as wanted by nted by race/et race/ethnicity

52.1 53.7

12.5

45.0 53.8

33.2 37.3 26.9 33.8

14.7 17.7 19.4

0

20

40

60

80

100

Total Hispanic Black White

Perc

e

nt

Always Usually Sometimes/never

Note: Total includes Hispanic, black, white, and other races not shown separately.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 2C

Among chil ong children < 18 dren < 18 who had appointm appointments for regul r regular or

routine healt ine health care inthe last he last 12 months, months, percent distribution of

getting them as soon a as soon as wanted by insurance stat surance status

52.1 54.2 49.4 42.4 40.1

33.2 33.1 30.5

14.7 12.6 20.1 17.5

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 3 Figure 3A

Percent of children < 18 who had a doctor's office or clinic visit 

(excluding emergency rooms) in the last12 months, by

race/et race/ethnicity

78.0 69.7 67.7 83.3 67.6

0

20

40

60

80

100

Total Hispanic Black White Other

Perc

e

nt Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 3B gure 3B

Among children < ong children < 18 who had a doctor's office or clin ce or clinic visit in

the last the last 12 months 12 months, percent di rcent distribution of tribution of problems in oblems in

receiving necessary care by care by race/et race/ethnicity

88.6 83.2 85.2 91.0

9.5 1.9 14.1 2.8 13.1 1.7 7.2 1.8

0

20

40

60

80

100

Total Hispanic Black White

Perc

e

nt

Not a problem A small problem A big problem

Note: Total includes Hispanic, black, white, and other races not shown separately.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 3C Figure 3C

Among children < 1 ong children < 18 who had a doctor's office or c ce or clinic visit in

the last 12 months, percent distribution of bution of problems in receiving 

necessary care by care by insurance status

11.7

88.6 92.1 79.6 84.2

9.5 1.9 7.0 16.5 4.1

1.0

3.8

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Not a problem A small problem A big problem

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 4 Figure 4A

Percent of chi t of children < 18 whose doctor or parent thought the rent thought they

needed t needed to see a specialist in the last 12 months, by insurance

status

18.1 20.5 15.5 10.4

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 4B

Among chil ong children < 18 dren < 18 whose doctor or ose doctor or parent thought t hought they needed to 

see a speci see a specialist in the last 12months, pe months, percent dist ent distribution of 

problems in getting a referral to a speci a specialist by insurance status

77.5 81.2 66.6 70.7

17.1 14.9 18.4

24.7

5.4 3.9 8.7 10.8

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Not a problem A small problem A big problem

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 5A

Among chi ong children < 18 who had a doct who had a doctor's office or clinic visitin

the last 12 months, per months, percent di cent distribution of how often their health 

providers listened ca ened carefully to their pa heir parents by rents by race/ethnicity

65.5 65.9

59.4

72.5

28.1 31.7 28.5

6.5 9.0 20.4 7.1 5.7

0

20

40

60

80

100

Total Hispanic Black White

Perc

e

nt

Always Usually Sometimes/never

Note: Total includes Hispanic, black, white, and other races not shown separately.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 5B

Among chi ong children < 18 who had a doct who had a doctor's office or clinic visitin

the last 12 months, per months, percent di cent distribution of how often their health 

providers listened ca ened carefully to their pa to their parents by insurance sta insurance status

57.1

65.5 67.2 63.9

28.1 28.4 23.7 35.3

6.5 4.4 12.4 7.6

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 6 Figure 6A

Among chil ong children < 18 en < 18 who had a o had a doctor's o ctor's office or clin ffice or clinic visit

in the last 12 he last 12 months, percent distribution tribution of how often their 

health providers exp ers explained thingscarefully by race/et race/ethnicity

68.4 62.0 74.3 69.1

25.9 28.7 26.5

5.7 9.3 18.4 7.4 4.5

0

20

40

60

80

100

Total Hispanic Black White

Perc

e

nt

Always Usually Sometimes/never

Note: Total includes Hispanic, black, white, and other races not shown separately.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 6B

Among children < 18 who had a doctor's had a doctor's office or clinic visit in 

the last 12 months, per months, percent di cent distribution of how often their health 

providers expl iders explained thi ained things caref ngs carefully by insurance status

68.4 70.9 63.7 61.6

25.9 25.7 24.4 30.4

5.7 3.4 11.9 8.0

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 7A

Among children <18 who had a doctor's office or clinic visit in the last 

12 months, percent distribution of ho bution of how often their health providers 

showed respect for what theirparent said by race/ethnicity

67.3 63.7 75.4 66.9

26.3 30.7 26.8

6.3 5.6 17.9 6.7 6.3

0

20

40

60

80

100

Total Hispanic Black White

Perc

e

nt

Always Usually Sometimes/never

Note: Total includes Hispanic, black, white, and other races not shown separately.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 7B

Among chi ong children < 18 who had a do o had a doctor's office or clinic visit in the last the last 

12 months, percent distribution of how often their health providers 

showed respect for ect for what their par eir parent said by insurance status

34.5

58.7

67.3 69.3 64.9

26.3 26.0 23.7

6.3 4.6 11.4 6.9

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000

Figure 8A

Among children <18 who had a doctor's officeor clinic visit inthe last 

12 months, percent distribution of bution of how often their health providers

spent enough t enough time with them and their par their parents by race/ethnicity

56.1 51.9 56.3

61.8

33.5 35.8 26.8 34.3

10.4 12.4 11.3 9.4

0

20

40

60

80

100

Total Hispanic Black White

Perc

e

nt

Always Usually Sometimes/never

Note: Total includes Hispanic, black, white, and other races not shown separately.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 8B

Among children <18 who had a doctor's officeor clinic visit inthe last 

12 months, percent distribution of bution of how often their health providers 

spent enough ti ough time withthem and their parents by insurancestatus

14.0

56.1 57.5 54.6 49.5

33.5 34.5 29.4 36.5

10.4 8.0 16.0

0

20

40

60

80

100

Total Any private Public only Uninsured

Perc

e

nt

Always Usually Sometimes/never

Note: Any private includes persons with private insurance or Champus/VA. Public only includes

persons without Any private but with public insurance. Uninsured includes persons without Any

private or Public only.

Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000