Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1155-1161 (doi:10.1542/10.1542/peds.2004-2403)
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Insurance Gaps Among Vulnerable Children in the United States, 1999–2001

Marlon Satchell, MPH* and Susmita Pati, MD, MPH*,{ddagger}

* Pediatric Generalist Research Group and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
{ddagger} Leonard Davis Institute of Health Economics and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Objective. To quantify the number of children who experience gaps in insurance coverage and to determine whether vulnerable subgroups of children experience noteworthy lapses in insurance coverage.

Methods. We analyzed nationally representative data from 24149 children sampled in the 1999–2001 Medical Expenditure Panel Survey linked to the 1997–1999 National Health Interview Survey. Vulnerable subgroups of children included children with chronic conditions, those from ethnic/racial minorities, and those living in poverty. On the basis of cumulative annual monthly insurance coverage status, each child fell into 1 of 3 groups: continuous coverage, uninsured, or gaps in coverage. Using SAS-callable SUDAAN, we conducted multivariate ordinal logistic regression model to quantify the likelihood of having gaps in coverage for vulnerable subgroups of children.

Results. From 1999 to 2001, we found that >9 million American children annually had gaps in coverage and that 5 to 6 million children annually were uninsured for the entire year. Sixty percent of children experienced gaps of at least 4 months, and >40% of all publicly and privately insured children had coverage gaps. After accounting for relevant covariates, children with chronic conditions were just as likely as other children to have gaps in coverage or be uninsured; Hispanic children were most likely to have insurance gaps or be uninsured; and children from poor and near-poor families were 4 to 5 times more likely to have lapsed coverage than children from high-income families. Poverty and maternal education were the strongest factors associated with lapsed coverage.

Conclusions. Unstable health insurance is an underrecognized problem for children, including those with chronic conditions. Because unstable insurance coverage can lead to inadequate health care utilization and poor child health outcomes, strategies to promote stable insurance coverage merit serious consideration.

Key Words: chronic conditions • health insurance • medically underserved • health insurance coverage gaps • ethnic disparity

Abbreviations: TANF, Temporary Assistance to Needy Families • MEPS, Medical Expenditure Panel Survey • HC, Household Component • MPC, Medical Provider Component • IC, Insurance Component • NHIS, National Health Interview Survey

Accepted Feb 4, 2005.


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