Related Experiment Video
Updated: Jul 18, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Children in the United States with discontinuous health insurance coverage
Lynn M Olson1, Suk-fong S Tang, Paul W Newacheck
1Department of Practice, American Academy of Pediatrics, Elk Grove Village, Ill 60007, USA. lolson@aap.org
Insights
Children with gaps in health insurance coverage experience significantly worse access to medical care, including delayed treatment and unfilled prescriptions. These findings highlight the need for better measures of insurance status beyond simple uninsured rates.
Area of Science:
- Health Services Research
- Pediatric Health
- Health Insurance Policy
Background:
- Estimates of uninsured populations often exclude children with discontinuous coverage.
- The impact of intermittent health insurance on children's healthcare access is not well understood.
Purpose of the Study:
- To investigate the association between gaps in health insurance coverage and access to ambulatory care for children in the United States.
Main Methods:
- Analysis of 26,955 children from the 2000-2001 National Health Interview Surveys.
- Comparison of children with discontinuous coverage versus those uninsured all year and those with full-year public or private coverage.
Main Results:
- Children with gaps in insurance had significantly higher rates of delayed care, unmet medical needs, and unfilled prescriptions compared to those with full-year coverage.
- Multivariate analyses confirmed that insurance gaps, not other factors, were strongly associated with poor access to care.
- Parents of children with partial-year uninsured periods were over 13 times more likely to report delaying care.
Conclusions:
- Gaps in health insurance coverage substantially impair children's access to essential medical services and prescriptions.
- Current measures of being uninsured may underestimate the true extent of access barriers for children.
- Policy and research should consider more comprehensive metrics for insurance continuity and its impact on child health.
Background:
Estimates of the number of uninsured people in the United States usually exclude those with discontinuous coverage. The effects of gaps in insurance coverage for children on access to and use of ambulatory care are poorly understood.
Methods:
We analyzed a sample of 26,955 children under 18 years of age from the 2000 and 2001 National Health Interview Surveys. Children with discontinuous health insurance coverage were compared with those who were uninsured all year and with those who had public or private full-year coverage.
Results:
During the last 12 months before they were interviewed, 6.6 percent of children in the United States had no insurance and an additional 7.7 percent had gaps in insurance. Children who had full-year insurance coverage (private or public) had low rates of unmet health care needs and good access to care (delayed care, unmet medical care, and unfilled prescriptions were reported in <3 percent, and <5 percent had no usual place of care). Access to care was much worse for children who were uninsured for part of the year and for those who were uninsured for the full year (delayed care, 20.2 percent and 15.9 percent, respectively; unmet medical care, 13.4 percent and 12.6 percent, respectively; unfilled prescriptions, 9.9 percent and 10.0 percent, respectively; P<0.01 for all comparisons with children with full-year, private insurance coverage). In multivariate analyses adjusting for age, income, race or ethnic group, region, citizenship, family structure, parental employment, and health status, the differences in access to care persisted. As compared with the parents of children with full-year, private insurance, parents of children uninsured for the full year were far more likely to report delaying care (adjusted odds ratio, 12.65; 95 percent confidence interval, 9.45 to 16.94), as were parents of children uninsured for part of the year (adjusted odds ratio, 13.65; 95 percent confidence interval, 10.41 to 17.90).
Conclusions:
Children with gaps in health insurance coverage commonly do not seek medical care, including preventive visits, and do not get prescriptions filled. These findings are important for both research and policy and point to the need for more encompassing and sensitive measures of the situation of being uninsured.
Related Concept Videos
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:30Preventive Healthcare Services
01:11Secondary Healthcare System
01:17Healthcare Agencies II
Parish nursing is a growing specialty nursing profession that focuses on holistic healthcare, health promotion, and illness prevention. It blends professional nursing practice with a health ministry, focusing on health and healing within the context of a Christian community. Parish nurses serve as health educators, referral sources, and lay...
01:23Continuity of a Function