Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e411-e418 (doi:10.1542/peds.2008-1874)
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ARTICLE

The Effects of Varying Periods of Uninsurance on Children's Access to Health Care

Janet R. Cummings, BAa, Shana Alex Lavarreda, MPPa,b, Thomas Rice, PhDa,b and E. Richard Brown, PhDa,b

a Department of Health Services, University of California, Los Angeles School of Public Health
b Center for Health Policy Research, University of California, Los Angeles, Los Angeles, California

OBJECTIVE. Many studies have documented the adverse consequences of uninsurance for children, but less is known about the differential effects of varying periods of uninsurance. This study examines the relative effects of varying periods of uninsurance (uninsured for 1–4 months, 5–11 months, or all year) on children's access to care.

METHODS. Using data from the 2005 California Health Interview Survey Children's File (ages 0–11), we estimated logistic regressions to examine the effect of insurance status on 6 measures of health care access, controlling for child demographics, child health status, family characteristics, and urban residence. Indicators for insurance status included the following categories: (1) privately insured all year (reference); (2) Medicaid all year; (3) State Children's Health Insurance Program all year; (4) uninsured for 1 to 4 months; (5) uninsured for 5 to 11 months; (6) uninsured all year; and (7) other insurance all year.

RESULTS. We found that children who experience short spells of uninsurance (1–4 months) are less likely to have a usual source of care and are more likely to experience delays in needed care than those with continuous private or public insurance. The consequences are even worse for children who experience more substantial periods of uninsurance, because they are also less likely to receive preventive care (well-child visits and flu shots) or visit the doctor during the year and are more likely to experience delays in receiving needed medical care and prescriptions than those with continuous coverage. The Medicaid program and State Children's Health Insurance Program in California both seem to have ensured levels of health care access similar to that obtained by children with year-round private coverage.

CONCLUSIONS. These findings highlight the benefits gained through continuous health insurance, whether public or private. Public policies should be adopted to ensure continuity of coverage and retention in public insurance programs.

Key Words: insurance coverage • delivery of health care • infant • child • preschool

Abbreviations: CPS—Current Population Survey • CHIS—California Health Interview Survey • SCHIP—State Children's Health Insurance Program • USOC—usual source of care • OR—odds ratio • CI—confidence interval

Accepted Nov 11, 2008.


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