WHAT EXPLAINS RACIAL/ETHNIC DISPARITIES IN HEALTH SERVICE UTILIZATION AMONG YOUNG CHILDREN? Christina H. Park, Neal Halfon, Moira Inkelas, Lynn M. Olson. Maternal and Child Health Bureau, Washington, DC; Pediatrics, UCLA, Los Angeles, CA; Public Health, UCLA, Los Angeles, CA; American Academy of Pediatrics, Elk Grove Village, IL.

BACKGROUND: Racial and ethnic disparities in primary care use persist despite public insurance programs. Disparities have been well documented in traditional measures of utilization (such as physician visits), but it is unknown whether disparities exist across all utilization measures, and whether these disparities are mediated by family and system characteristics.

OBJECTIVE: To examine racial/ethnic differences in patterns of health service utilization in young children and to explore the factors that contribute to these differences.

DESIGN/METHODS: The National Survey of Early Childhood Health is a telephone survey of a national random sample of 2,068 children 4 to 35 months old. Accounting for the complex survey design, mean utilization levels were compared, and multivariate logit regression analysis was conducted. Utilization variables were: well child care visits, calls made to doctor?s office for medical consultation, doctor office visits, emergency room visits, hospital admissions, and referrals to specialists.

RESULTS: Bivariate results indicate significant differences in the patterns of health service utilization by race/ethnicity. Much disparity disappeared or diminished when adjusted for other factors. Significant differences remained in that, compared to whites, both Hispanic and black children were far less likely to have calls made by parents to doctor?s office, Hispanic children of Spanish-speaking parents were likely to have fewer visits to a doctor?s office when sick. Among the explanatory variables, the maternal factors most significantly diminished, but did not eliminate, racial/ethnic differences.

CONCLUSIONS: Significant racial/ethnic differences persisted for a number of health care utilization measures in young children that are not as commonly included in access to care studies (eg. phone consultations, well child care visits, and referrals to specialists). While the child?s health needs were the strongest predictors of health service utilization, maternal/family characteristics contributed most to racial or ethnic disparities in health service use. Future studies should focus on utilization factors such as phone consultation because such contact may improve continuity of care and reduce emergency department use for low-income families who face barriers to physically accessing care.