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The Importance of Continuous Health Insurance for Children's Access To Care

Lynn M. Olson, Suk-fong S. Tang, Paul Newacheck. American Academy of Pediatrics, Elk Grove Village, IL; Health Policy Studies, UCSF, San Francisco, CA.

Background: Estimates of the number of uninsured US children exclude many with discontinuous coverage; the effects of these gaps and, conversely, the value of continuous coverage are poorly understood.

Objective: Examine the effect of continuous insurance on children's access to and use of ambulatory care.

Design/Methods: Analyses were based on a sample of 26,955 children < 18 years from the 2000-2001 National Health Interview Surveys. Access and use were compared for children with discontinuous insurance, those uninsured all year and those with full-year coverage, both public and private. The relationship of insurance to outcomes was also examined through logistic regression (models included health status, income, race/ethnicity, parent employment).

Results: In 2000-2001, 6.6% of US children had no insurance the past 12 months; an additional 7.7% had gaps in insurance. Children insured the full year, whether public or private, had similar low rates of problems. In contrast, those fully or partly uninsured had substantial reported access problems. The percent of children part-year uninsured and full-year uninsured with problems were as follows: delayed care (20.2%; 15.9%), unmet medical care (13.4%; 12.6%), unfilled prescriptions (9.9%; 10%), no usual place for care (15%; 38%), no well child visit (37.2%; 58.7%), and no doctor visit (17.2%; 39%) the past 12 months. In multivariate analyses the same relationships were found, eg, children uninsured a full year had odds 12.4 times greater than those privately insured all year of experiencing delayed care and children uninsured part year had odds 13.6 times greater, while full-year publicly insured children had no greater odds. Insurance effects were substantially greater than family income, race/ethnicity or child's health status. 

Conclusions: Continuous insurance coverage, whether public or private, eliminated or substantially reduced access problems. In multivariate analyses the effects of continuous insurance were far greater than the child's health status, family income or the child's race or ethnicity. Children with insurance gaps experience notable problems: they fail to get medical care, go without prescriptions filled or do without preventive visits. Most of these children are eligible for some form of coverage, pointing to the critical policy and programmatic need for efforts to get and keep children enrolled.

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