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Insurance Coverage Disruption Among Children and Caregivers After Pediatric Hospitalization
Erin F Carlton1,2,3, Rachel Parent4, Kao-Ping Chua2,3,5
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
Insights
A child's hospitalization increases the risk of health insurance coverage disruption for both the child and their caregiver. This disruption is more pronounced in families with longer hospital stays or fewer insured caregivers.
Area of Science:
- Health Services Research
- Pediatric Health
- Insurance Studies
Background:
- Health events can lead to disruptions in health insurance coverage.
- Understanding the impact of pediatric hospitalizations on insurance continuity is crucial for privately insured families.
Purpose of the Study:
- To estimate the association between a child's hospitalization and subsequent health insurance coverage disruption.
- To analyze this association for both the child and their caregivers.
Main Methods:
- Utilized the MarketScan Commercial Database (July 2016-June 2022) to identify hospitalized and matched non-hospitalized children (0-17 years).
- Assessed health insurance coverage disruption in the 6 months post-discharge using multivariable logistic regression.
- Conducted subgroup analyses based on length of stay, caregiver type, sex, and household insurance structure.
Main Results:
- Hospitalized children (1.3 percentage points increase) and their caregivers (1.0 percentage points increase) experienced significantly higher rates of insurance coverage disruption compared to non-hospitalized controls.
- The risk of coverage disruption was elevated for children with longer hospital stays and in households with only one insured caregiver.
- Statistical significance was confirmed with P < .001 for both children and caregivers.
Conclusions:
- Pediatric hospitalization is a significant risk factor for health insurance coverage disruption among privately insured children and their families.
- This disruption may impact access to care for recently hospitalized children, particularly those in vulnerable subgroups.
- Findings highlight the need for strategies to ensure insurance continuity following pediatric hospitalizations.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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