Elsevier

Ambulatory Pediatrics

Volume 8, Issue 5, September–October 2008, Pages 321-328
Ambulatory Pediatrics

Insurance, Information Technology, Economics of Interventions
The Impact of Insurance Instability on Children's Access, Utilization, and Satisfaction with Health Care

https://doi.org/10.1016/j.ambp.2008.04.007Get rights and content

Objectives

We describe instability of health insurance coverage for children aged 2 to 17 years and relate insurance instability to access, utilization and satisfaction.

Methods

Three 2-year panels of the Medical Expenditure Panel Survey were used to measure insurance instability and its relationship to access, utilization, and problems with medical care.

Results

Over a 2-year period, 53% of children were continuously insured with private coverage, 19% had continuous public insurance, 20% had a single gap in coverage, 2% had multiple gaps, and 6% were continuously uninsured. Compared with children continuously insured through private coverage, children with single or multiple gaps or who were continuously uninsured were significantly more likely to lack a usual source of care (adjusted odds ratios [AORs] = 2.3, 3.5, and 4.5, respectively), to have no well-child visits (AORs = 1.2, 2.2 and 2.4, respectively), and to have unmet medical or prescription drug needs (AORs = 4.5, 4.2 and 3.4, respectively). There were no significant differences between children continuously insured through private coverage and children with single or multiple gaps or continuously uninsured and having at least 1 problem with medical care (AORs = 0.8, 1.3, and 1.4, respectively). While there were no differences between children continuously insured through private coverage and children with multiple gaps or continuously uninsured, children with single gap in coverage were significantly more likely to report having at least one problem with medical care (AOR = 1.5).

Conclusions

Compared with those with continuous coverage, children with gaps in coverage—especially those with multiple gaps—are less likely to have a usual source of care and receive well-child care. The national debate should incorporate discussions of policies to promote not only expansions of coverage, but also initiatives to eliminate gaps in coverage.

Section snippets

Data Source

MEPS, a federally sponsored survey containing a series of questionnaires administered in person and by telephone 5 times (5 rounds) in overlapping 2-year panel periods,16 was used for this study. This survey provides nationally representative estimates for insurance coverage, access, utilization, and satisfaction with health care, as well as other sociodemographic variables. During the course of a calendar year, data for 2 separate but overlapping panels are collected, such that while the first

Insurance Coverage Patterns

We found that 53% of children were continuously covered by private insurance during the entire 2-year panel period, 19% were continuously insured with public coverage during the panel period, whereas 6% had no insurance coverage at any time during the panel period (Figure). Over one fifth of children experienced 1 or more gaps in coverage during the 2 years. Although only 2% of all children experienced multiple gaps in coverage (having an average length of gap of 5.3 months), fully 20% of

Discussion

This is the first study, to our knowledge, that describes children's patterns of health insurance coverage over an extended time period. Although we found the most common pattern over the 2-year study period to be continuous coverage through either public or private insurance, substantial numbers of children had single or multiple gaps or were uninsured for the entire time. Our analysis showed that most of the children who lacked coverage at some time had a single gap—12.8 million

Conclusions

This study suggests that stable, continuous coverage raises the likelihood that children will have a usual source of care and receive timely well-child care. These outcomes are fundamental components of high-quality health care. The national debates often focus on policies to extend coverage to presently uninsured and ignore problems of instability. That debate should incorporate discussions of policies promoting not only expansions of coverage, but also initiatives to eliminate gaps in

Acknowledgment

This research was funded by grant R40MC06633 from the Health Resources and Services Administration to GF.

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