Determinants of children’s health care use: An investigation of psychosocial factors

Anne W. Riley, Jack W. Finney, E. David Mellits, Barbara Starfield, Shari Kidwell, Shirley Quaskey, Michael F. Cataldo, Laura Filipp, Jon P. Shematek

Research output: Contribution to journalArticle


Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while children’s depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of children’s health care use. When included in a comprehensive analysis, child and family psychosocial characteristics help to explain children’s health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed.

Original languageEnglish (US)
Pages (from-to)767-783
Number of pages17
JournalMedical care
Issue number9
StatePublished - Sep 1993


  • Children’s health care
  • Pediatrics
  • Psychosocial factors
  • Utilization

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Riley, A. W., Finney, J. W., Mellits, E. D., Starfield, B., Kidwell, S., Quaskey, S., Cataldo, M. F., Filipp, L., & Shematek, J. P. (1993). Determinants of children’s health care use: An investigation of psychosocial factors. Medical care, 31(9), 767-783.