Inequalities in Health Risks, Morbidity and Health Care of Children by Health Insurance of Their Parents (Statutory vs. Private Health Insurance): Results of the German KiGGS Study

Aim of the Study: In Germany, differences in health risks, morbidity and health care between children whose parents are insured either in the statutory or in the private health insurance (in German: GKV or PKV respectively) have rarely been studied. Recent studies have shown that adults who are insured in the GKV tend to be less healthy and tend to seek primary health care more frequently than those who are insured in the PKV. The study presented here focuses on the hypothesis that similar inequalities also exist between their children. Methods: The analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), i.e., a large and representative study (n =17641; response rate: 66.6%) conducted 2003/2006. 3 groups of outcome variables are distinguished: health risks (e.g., smoking, breast-feeding), morbidity (e.g., self-rated health, psychological wellbeing) and health care (e.g., utilization of primary care physicians and of preventive services). First, bivariate associations between health insurance (GKV vs. PKV) and outcomes were analysed by chi-square tests. Then, the significant associations were tested further in logistic regression models including other variables such as age, sex, national origin and socioeconomic status (SES). We also included analyses stratified by sex and SES. Results: The bivariate analyses show that there are many significant differences between GKV- and PKV-insured children in terms of health risks, morbidity and health care. After controlling for the other variables in the logistic regression, most of these associations become statistically insignificant. Some remain significant, though, for example: Reduced breast-feeding is more common in the GKV group (OR = 1.17; 95% CI 1.03-1.34), smoking is more prevalent in this group as well (OR = 1.41; 95% CI 1.04-1.91), and GKV-insured children seek primary health care more frequently than PKV-insured (OR = 1.27; 95% CI 1.05-1.54). Conclusion: Health risks are usually greater among GKV-insured children as compared with PKV-insured. Concerning morbidity, these differences can mainly be explained by differences in national origin and SES. Efforts aimed at reducing these health differences should therefore focus on risks associated with migration and low SES. In addition, differences concerning risk factors such as smoking could not be explained by differences in national origin and SES. Thus, there seems to be a general need for more preventive measures in the GKV (i.e., independent of national origin and SES).