Children in the United States with Discontinuous Health Insurance Coverage

Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States
New England Journal of Medicine (Impact Factor: 55.87). 08/2005; 353(4):382-91. DOI: 10.1056/NEJMsa043878
Source: PubMed


Estimates of the number of uninsured people in the United States usually exclude those with discontinuous coverage. The effects of gaps in insurance coverage for children on access to and use of ambulatory care are poorly understood.
We analyzed a sample of 26,955 children under 18 years of age from the 2000 and 2001 National Health Interview Surveys. Children with discontinuous health insurance coverage were compared with those who were uninsured all year and with those who had public or private full-year coverage.
During the last 12 months before they were interviewed, 6.6 percent of children in the United States had no insurance and an additional 7.7 percent had gaps in insurance. Children who had full-year insurance coverage (private or public) had low rates of unmet health care needs and good access to care (delayed care, unmet medical care, and unfilled prescriptions were reported in <3 percent, and <5 percent had no usual place of care). Access to care was much worse for children who were uninsured for part of the year and for those who were uninsured for the full year (delayed care, 20.2 percent and 15.9 percent, respectively; unmet medical care, 13.4 percent and 12.6 percent, respectively; unfilled prescriptions, 9.9 percent and 10.0 percent, respectively; P<0.01 for all comparisons with children with full-year, private insurance coverage). In multivariate analyses adjusting for age, income, race or ethnic group, region, citizenship, family structure, parental employment, and health status, the differences in access to care persisted. As compared with the parents of children with full-year, private insurance, parents of children uninsured for the full year were far more likely to report delaying care (adjusted odds ratio, 12.65; 95 percent confidence interval, 9.45 to 16.94), as were parents of children uninsured for part of the year (adjusted odds ratio, 13.65; 95 percent confidence interval, 10.41 to 17.90).
Children with gaps in health insurance coverage commonly do not seek medical care, including preventive visits, and do not get prescriptions filled. These findings are important for both research and policy and point to the need for more encompassing and sensitive measures of the situation of being uninsured.

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    • "Insurance coverage is often identified as the most crucial determinant for health care utilization, especially in countries without universal coverage (Abdus and Selden, 2013; Cummings et al., 2009; Dietz et al., 2012; Holl et al., 1995; Kogan et al., 2010). Evidence from the United States consistently indicates that none-or discontinuously insured children, as compared with fully insured ones, were more likely to experience delays in receiving needed health services and to have difficulties in accessing a usual source of care, including preventive healthcare (Cummings et al., 2009; Holl et al., 1995; Olson et al., 2005). Given the importance of health insurance coverage, some strategies have been implemented at national, state, or local levels to reduce the access barriers (e.g., universal health care, social insurance, and special program), yet the related benefits can still be underutilized. "
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    • "Eligibility Criterion 1 was chosen to target the spectrum of uninsured children, from those who have been continuously uninsured for the prior year or longer, to the discontinuously/ episodically uninsured who currently have no insurance, but were insured for part of the prior year. Research documents that children uninsured for part of the year have comparable outcomes to those uninsured for the full year, in terms of access to healthcare, unmet healthcare needs, and use of health services [21]. The research team queries appropriate state Medicaid and CHIP program representatives at the Texas Health and Human Services Commission to verify that the child does not currently have active Medicaid or CHIP coverage. "
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    • "This may explain why our estimate of the number of children experiencing insurance transitions is greater than estimates from prior studies 3 The mean months in each category may sum to less than 12 because the sample includes infants less than one year old, or they may sum to more than 12 because some children are reported receiving both private and public insurance at the same time. using survey questions with a 12 month recall period, such as in the NHIS or the NSAF (Olson et al. 2005; Aiken et al. 2004). 4 Abstracting from the issue of response error, the data in Figure 1 suggest that for most children, periods without insurance are relatively short. "
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