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.

Full-text preview

Available from:
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Children of heroin-using women have a higher risk of unfavorable health and developmental outcomes. Although methadone maintenance treatment (MMT) has been widely used to treat heroin-using pregnant women, potential effects on accessibility and utilization of healthcare service for their offspring are less explored. We used four national registry and health insurance datasets in Taiwan from 2004 to 2009 to form a population-based matched retrospective cohort study. A total of 1056 neonates born to women in the MMT program (857 born before mother's enrollment in the MMT program [BM], 199 born after mother's enrollment in the MMT program [AM]) was established; 10547 matched non-drug [ND] exposed neonates were identified for comparison. Outcome variables included offspring's health insurance coverage and utilization of preventive, outpatient, and emergency room cares in the first year after birth. Infants born to mothers on MMT were more likely to have no or incomplete insurance coverage (BM: adjusted odds ratio [aOR]=1.29, 95% CI: 1.10-1.53; AM: aOR=1.56, 95% CI: 1.14-2.13) as compared with the socioeconomic status-matched ND group. The BM infants appeared to have fewer preventive care visits (adjusted relative risk [aRR]=0.85, 95% CI: 0.80-0.90), whereas the AM infants utilized outpatient and emergency room services more frequently (outpatient: aRR=1.11, 95% CI: 1.01-1.23; emergency: aRR=1.46, 95% CI: 1.11-1.90). Addiction treatment and harm reduction programs for women of childbearing ages should be delivered in the coordinated framework that ensures comprehensiveness and continuity in healthcare and social services. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Full-text · Article · Jun 2015 · Drug and alcohol dependence
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Six million US children have no health insurance, and substantial racial/ethnic disparities exist. The design, methods, and baseline characteristics are described for Kids' Health Insurance by Educating Lots of Parents (Kids' HELP), the first randomized, clinical trial of the effectiveness of Parent Mentors (PMs) in insuring uninsured minority children. Latino and African-American children eligible for but not enrolled in Medicaid/CHIP were randomized to PMs, or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents with ≥1 Medicaid/CHIP-covered children. PMs received two days of training, and provide intervention families with information on Medicaid/CHIP eligibility, assistance with application submission, and help maintaining coverage. Primary outcomes include obtaining health insurance, time interval to obtain coverage, and parental satisfaction. A blinded assessor contacts subjects monthly for one year to monitor outcomes. Of 49,361 candidates screened, 329 fulfilled eligibility criteria and were randomized. The mean age is seven years for children and 32years for caregivers; 2/3 are Latino, 1/3 are African-American, and the mean annual family income is $21,857. Half of caregivers were unaware that their uninsured child is Medicaid/CHIP eligible, and 95% of uninsured children had prior insurance. Fifteen PMs completed two-day training sessions. All PMs are female and minority, 60% are unemployed, and the mean annual family income is $20,913. Post-PM-training, overall knowledge/skills test scores significantly increased, and 100% reported being very satisfied/satisfied with the training. Kids' HELP successfully reached target populations, met participant enrollment goals, and recruited and trained PMs. Copyright © 2014 Elsevier Inc. All rights reserved.
    Full-text · Article · Dec 2014 · Contemporary Clinical Trials
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Even as the number of children with health insurance has increased, coverage transitions-movement into and out of coverage and between public and private insurance-have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.
    Preview · Article · Feb 2014 · International Journal of Health Care Finance and Economics
Show more