Insurance Coverage Disruption Among Children and Caregivers After Pediatric Hospitalization

Health events may disrupt insurance coverage. We estimated the association between a child's hospitalization and insurance coverage disruption among privately insured children and caregivers.

Using the MarketScan Commercial Database, we identified children (0-17 years) with a hospitalization from July 2016 to June 2022. Children were matched on observable characteristics with nonhospitalized children, who were randomly assigned a "phantom" discharge date. The primary outcome was health insurance coverage disruption in the 6 months post index/phantom hospitalization discharge. We examined this separately among children and caregivers via multivariable logistic regression and reported the average marginal effect (AME) of coverage disruption for the hospitalization. We performed subgroup analyses including length of stay category for children and caregiver type (primary plan-holder vs spouse), sex, and household structure (1 vs 2 insured caregivers) for caregivers.

In total, 219 512 hospitalized children were matched to 715 143 nonhospitalized children, and 369 406 and 1 207 958 caregivers of hospitalized and nonhospitalized children, respectively, were identified. The predicted probability of coverage disruption was significantly higher for the hospitalized cohort of children (hospitalized percentage points 0.170; comparison group 0.156; AME, 1.3 percentage points; 95% CI, 0.011-0.014; P < .001) and their caregivers (hospitalized percentage points 0.165; comparison group 0.155; AME, 1.0 percentage points, 95% CI, 0.008-0.012; P < .001). The risk of insurance coverage disruption associated with hospitalization was higher among families of children with longer lengths of stay and with 1 insured caregiver on the insurance plan.

Pediatric hospitalization is associated with an increased risk of insurance coverage disruption for the child and their caregiver among privately insured individuals. This could reflect a change in access to care for recently hospitalized children, especially those in certain subgroups.