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Childhood Underinsurance in Primary Care: A Practice-Based Study.
Brooklynne A S Dilley-Maltenfort1, Samantha A Roberts1, Serena K Kaul1
1Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA.
Healthcare (Basel, Switzerland)
|October 16, 2025
Summary
Approximately 1 in 9 children in Ohio were underinsured, facing challenges accessing care and experiencing negative impacts from COVID-19. Parental education and private insurance were linked to this underinsurance.
Area of Science:
- Pediatric Health
- Health Services Research
- Public Health
Background:
- Child health insurance coverage is vital, but underinsurance persists in the U.S.
- Underinsurance significantly impacts children's access to healthcare and overall well-being.
- The COVID-19 pandemic exacerbated existing challenges in healthcare access for children.
Purpose of the Study:
- To determine the prevalence of childhood underinsurance in southwestern Ohio.
- To identify factors associated with childhood underinsurance during the COVID-19 pandemic.
- To explore the impact of underinsurance on healthcare access and child outcomes.
Main Methods:
- Cross-sectional study of 1252 children (6 months to <18 years) and their primary caregivers (PCGs).
- Data collected via the Medical Expenses of Children Survey (MEoCS) in pediatric practices.
- Underinsurance defined by PCG-reported inability to afford recommended care despite having insurance; analyzed using chi-squared tests and logistic regression.
Main Results:
- 11.3% of children were underinsured.
- PCGs of underinsured children reported significantly greater difficulty accessing care (41.5% vs. 9.5%).
- Underinsured children's families reported greater negative impacts of COVID-19 on income, school performance, and mental health.
Conclusions:
- Nearly 1 in 9 children in the study were underinsured.
- Lower parental education and private health insurance emerged as consistent correlates of underinsurance.
- Addressing underinsurance is crucial for improving child health outcomes and equitable healthcare access.
Keywords:
Affordable Care ActCOVID-19Ohiochild healthcross-sectional studiesinsurance coveragemedically underinsuredpopulation healthprimary caresurveys and questionnairesMore Related Videos
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