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