The Association of Insurance Type and Geographic Setting with Well-Child Visit Duration Before, During and After the COVID-19 Pandemic

Abstract

Introduction Well-child visits (WCVs) are critical for growth, development, and injury and illness prevention for children. WCVs are intended to address a wide range of health needs, yet delivering services requires adequate time. Declining health care system capacity, policy changes and physician shortages during the COVID-19 pandemic may have impacted WCV duration, especially among rural children and children enrolled in Medicaid. How disparities in WCV duration by rurality and insurance type changed across time remains unknown. This study examined the association of insurance type, rurality and WCV duration across time periods. Methods This study is a cross-sectional study design using data from the National Survey of Children’s Health from 2019-2024 among children aged 3-10 who had a WCV in the last 12 months, without Down syndrome or special health care needs. Insurance type and rurality were the primary exposures, and WCV duration was the primary outcome (short: <10 minutes, long: ≥10 minutes). Logistic regression was used to estimate odds ratios (95% CI) of primary exposures and the outcome, adjusting for key covariates: child age, sex and race. Time period was assessed as a potential effect modifier. Results 68,205 children were included in our sample. Children with public insurance had higher odds of a short WCV compared to children with private insurance (1.12; 95% CI, 1.07-1.17). This association was not modified by year, remaining relatively unchanged across survey years. Children from rural areas also had higher odds of a short WCV than urban children pre-pandemic (OR, 1.27; 95% CI, 1.07-1.51), during the pandemic (OR, 1.11; 95% CI, 1.04-1.18) and post-pandemic (OR, 1.20; 95% CI, 1.18-1.30). There is some evidence that this association was modified by year. Discussion Having public insurance and rural residence were associated with short WCVs across survey years 2019-2024. Prior research among adult patients found longer visit duration to be a facilitator of future attendance at preventative care visits and an indicator of health care quality. Additionally, WCVs of longer duration are associated with better delivery of preventative care services, perhaps leaving children exposed to short visits at risk of poorer health outcomes. Bolstering the pediatrician workforce in rural areas through incentive programs and improving Medicaid reimbursement rate structures could be mechanisms for longer appointment durations among rural and publicly insured children. We recommend future studies examine the relationship of visit duration and future visit attendance among children, as this has only been assessed in adults.