Because previous studies have suggested differences in treatment choices and referral by insurance status, we examined the effect of insurance status on clinician recognition of psychosocial problems for pediatric primary care visits.

We conducted a cohort study in two large primary care research networks(ASPN and PROS) with one visit for each of 5,400 children, aged 4-15 years, presenting for nonemergency care in consecutive visits to the primary care practices of 94 clinicians (≈60/clinician) in 23 states and 2 provinces. Parents and clinicians completed forms for each visit. Children were classified as positive for psychosocial problems if their score on the Pediatric Symptom Checklist exceeded the standard cutoff of 28. Clinician recognition was obtained by report as a dichotomous variable. Insurance status was categorized as Uninsured (U), Fee For Service (FFS), Managed Care (MC), and Canadian Medicare (CM).

As with prior studies of recognition, clinicians did not recognize a sizable number of children with scores suggestive of significant psychosocial dysfunction on the PSC. FFS (Sens 57.2%) and CM (Sens 56.4%) patients were not statistically more likely than MC (Sens 54.4%) patients to be recognized. Neither Medicaid nor U patients were less likely to be recognized. Several patient and provider factors (e.g. severity of problems and familiarity with provider), but not insurance type, are likely associated with higher recognition rates.

Insurance status is not related to clinician recognition of psychosocial problems in pediatric primary care. Differences in treatment and utilization among various insurance groups documented in prior studies are not likely to be related to varying recognition rates, but rather to availability and choices of treatment by families and providers.