Barriers to medical care exist for children as for adults. Barriers revolve around affordability of care, availability of providers, and the need for medical care as reflected in health status of the individual. Kleinman et al (1981) showed that, regardless of income, black children in poor or fair health had fewer visits to a physician than their white counterparts with similar health status.

The data from the 1987 National Medical Expenditure Study were used to assess whether black and Hispanic children were more likely to experience barriers to health services than white children. The 1987 National Medical Expenditure Study was designed to provide national representation of health care use among the United States civilian non-institutionalized population. This analysis was limited to 58,878 children from 1 to 17 years of age. Of the study population of children, 70% were identified as non-Hispanic white, 15% as non-Hispanic black, and 11% as Hispanic.

The black and Hispanic children were disproportionately represented in terms of factors that relate to barriers to medical care. 46% of black and 40% of Hispanic children lived in poverty compared with 12% of the white children. Similarly, 56% of black and 33% of Hispanic children lived in a female-headed household compared with 15% of the white children. Black and Hispanic children were also more likely to be insured than the white children. 14% of the white children were uninsured, while 22% of the black and 33% of the Hispanic children were. Among the children living in poverty, 38% of white, 30% of the black, and 49% of Hispanic were uninsured.

Furthermore, geographical location of residence may influence access to health care. Residents of inner city and rural areas are more likely to have limited choices of health care providers. 21% of the white children lived in large urban areas, while 30% of black and 36% Hispanic children lived in these areas. Many southern states have Aid to Families with Dependent Children restrictions that decrease the number of recipients who would be Medicaid eligibility. 62% of black children resided in the south compared to 31 and 39% of the white and Hispanic children respectively. Perceived health care status reflects the need for care. Parents of black and Hispanic children were twice as likely to report that their children were in fair or poor health compared with parents of white children. Also, the source of the health care affects continuity of the care. Hospital outpatient clinics or emergency rooms are associated with lack of continuity of care. Regardless of insurance coverage, black and Hispanics children were more likely to have no usual source of care and hospitals were the chosen sites if they received usual care compared to white children. The use of preventive services varied by race and insurance coverage. 29% of the white children, 22% of the black and 18% of the Hispanic children saw a provider for a routine check-up or well-child examination at least once during 1987. However, 18% of uninsured white children and 11% of uninsured black and Hispanic children had at least one routine visit. A greater racial differential existed for dental visits. 52% of the white children, 28% of the black and 26% of the Hispanic children had at least one dental visit 1987.

Black and Hispanic children were confronted with more barriers to health services than white children. They were more likely to be poor, come from female-headed households, lack health insurance coverage, and live in rural or inner cities. Although having insurance coverage reduced the racial disparity in use, disparities persisted with regard to site of source of care (physician office vs. hospital or clinic) and convenience of care. Among children with health coverage, 91% of the white, 52 % of blacks and 58% of Hispanic children had private coverage. Expansion of Medicaid may help address the health care need of the poor children. However, “even with the current extensions of the Medicaid program a considerable portion of the poor would remain at risk for being uninsured because of the link between eligibility of Aid to Families with Dependent Children or Supplemental Security Income and enrollment in Medicaid programs.”