Health Care for Poor Children in the United States: A Full-time vs Part-time Solution

Sir.—Recently, the issue of providing primary health care for poor and uninsured or underinsured patients has received much attention in the medical literature. According to an Index Medicus search, in 1990 alone, there were 117 articles published in medical journals regarding health care for these patients. The attention is justified, because the problem of providing access to primary care for indigent patients, particularly indigent pediatric patients, is monumental. Between 30 and 40 million Americans lack health insurance, either public or private, and one third of these are infants and children.^1-3 According to the National Health Interview Survey, only two thirds of all poor children under age 6 years had some type of health insurance in 1986, with less than one half of the insured covered by Medicaid.⁴ Children who lack health insurance have decreased access to care, use fewer health services, and are more likely to have