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Published online August 1, 2005
PEDIATRICS Vol. 116 No. 2 August 2005, pp. 345-351 (doi:10.1542/peds.2004-2085)
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Unworried Parents of Well Children: A Look at Uninsured Children Who Reportedly Do Not Need Health Insurance

Stephen J. Blumberg, PhD*, Kathleen S. O'Connor, MPH*, Genevieve Kenney, PhD{ddagger}

* Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland
{ddagger} Urban Institute, Washington, DC

Objectives. We examined the characteristics of uninsured children from low-income households whose parents reported that health insurance coverage was not needed.

Methods. With data from the 2001 National Survey of Children With Special Health Care Needs, we used logistic-regression analyses to investigate the odds of reporting that uninsured children do not need insurance for various sociodemographic groups and children of varying health status. We also explored the odds of health care use, awareness of Medicaid and the State Children's Health Insurance Program (SCHIP), and desire to enroll according to the reported need for insurance.

Results. Parents of 6.8% of uninsured children from low-income households reported that their children did not need insurance. Rates were highest for American Indian/Alaska Native children (15.2%) and children whose parents completed the interview in a non-English language (10.6%). Rates were lowest for children with special health care needs (2.8%) and children with ≥7 school absences attributable to illness or injury in the past year (2.6%). Relative to children with another reason for lacking insurance, children who reportedly did not need insurance were less likely to have needed (adjusted odds ratio: 0.49) or used (adjusted odds ratio: 0.45) health care services in the past year and their parents were less likely to have heard of Medicaid or SCHIP (adjusted odds ratio: 0.58) or to have a desire to enroll their children if their children were eligible for Medicaid or SCHIP (adjusted odds ratio: 0.25).

Conclusions. Increasing participation among uninsured children whose parents do not perceive a need for insurance coverage may require more than simply increasing knowledge about the availability of public insurance programs.

Key Words: health insurance coverage gaps • health service utilization • parental attitudes • parental beliefs

Abbreviations: CSHCN, children with special health care needs • SCHIP, State Children's Health Insurance Program • AIAN, American Indian/Alaska Native

Accepted Dec 2, 2004.


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