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Updated: Sep 20, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Uninsured children: how we count matters
Suk-fong S Tang1, Lynn M Olson, Beth K Yudkowsky
1Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, Illinois 60007, USA. stang@aap.org
Insights
Including children with part-year coverage gaps more than doubles the estimated uninsured child population. This highlights the need to consider short-term uninsured spells in health policy and public insurance program evaluations.
Area of Science:
- Health Services Research
- Public Health Policy
- Pediatric Health Insurance
Background:
- Children uninsured for less than a full year are often misclassified as insured.
- This leads to underrecognition of their healthcare needs and underrepresentation in policy debates.
- They are also overlooked as potential beneficiaries of public insurance programs.
Purpose of the Study:
- To evaluate the impact of using alternative definitions of childhood insurance coverage on estimates of the uninsured population.
- To assess how different measurement approaches affect the perceived scale of childhood uninsurance.
- To inform health policy by providing a more comprehensive understanding of children's insurance gaps.
Main Methods:
- Analysis of monthly health insurance coverage data for US children aged 0-18 from the 1999 Medical Expenditure Panel Survey.
- Estimation of the prevalence of part-year and full-year uninsured children.
- Calculation of uninsured gap duration and aggregate uninsured spells.
Main Results:
- In 1999, 6.6 million children (8.4%) were uninsured for the entire year.
- An additional 11.4 million children (14.4%) experienced periods of uninsurance during the year.
- Part-year uninsured gaps constituted 41.7% of the total 130 million months of missing health coverage.
Conclusions:
- Varying definitions of uninsurance significantly alter the estimated number of uninsured children.
- Including part-year uninsured children more than doubles the estimated uninsured population and increases aggregate uninsured months by 71%.
- Children with part-year insurance gaps should be included in evaluations of public insurance programs like the State Children's Health Insurance Program (SCHIP).
Background:
Because children uninsured for less than a full year are often reported as insured, they receive less attention in health policy debates than do the full-year uninsured and are underrecognized as potential users of public insurance programs.
Objective:
The purpose of this study is to assess the impact on estimates of how many US children are uninsured when alternatives to the full-year uninsured definition are used.
Methods:
Monthly health insurance coverage data collected from children through age 18 in the 1999 Medical Expenditure Panel Survey were analyzed to estimate prevalence of health insurance gaps among children in terms of the size of part-year and full-year uninsured child population, duration of uninsured gaps, and aggregate uninsured spells.
Results:
Although 6.6 million ([M] 8.4%) children in the United States were uninsured throughout 1999, an additional 11.4M (14.4%) were uninsured for part of the year. Part-year uninsured gaps accounted for 41.7% of a total of 130M months of missing coverage experienced by all children.
Conclusions:
Different definitions and measures of who are uninsured can project radically different pictures of the magnitude of the problem. As this study shows, including the part-year uninsured more than doubled the estimated uninsured child population for 1999, and increased the estimated aggregate uninsured months by 71%. As potential users of public coverage, children who have no insurance for part of the year should be included when evaluating challenges to and accomplishments by the State Children's Health Insurance Program and other public programs. Their significant numbers and the potential burden they place on the health care delivery system argue for them to be counted and for the causes and consequences of short-term uninsured spells to be better understood.
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