Access to Care

Gaps in children's health insurance are linked to unmet health care needs

Low-income children who go without health care coverage for even as little as a few months risk having unattended health needs, a new study finds. Jennifer E. DeVoe, M.D., D. Phil., of Oregon Health and Science University, and colleagues received surveys from 2,681 families with children that were enrolled in Oregon's food stamp program at the end of January 2005. Oregon was chosen because it has a 6-month waiting period before parents can enroll children in the State Children's Health Insurance Program. The State also mandates re-enrollment every 6 months. Both requirements can cause gaps in coverage.

Surveyed families reported that a quarter of children had coverage gaps during the previous 12 months. These gaps included less than 6 months (17.5 percent), 6 to 12 months (1.5 percent), and more than 12 months (3.1 percent). Almost 4 percent of the children never had health insurance coverage. Children most likely to experience gaps were older than 14, were Hispanic, lived with families that had no incomes or had incomes just above the Federal poverty level, and had an unemployed parent.

Researchers found that the longer the insurance gap, the higher the chance of a child having an unmet health care need. These included not receiving medical or dental care, unfilled prescriptions, not having a usual source of care, and delaying urgent care when it was needed. For example, compared with children without coverage gaps, children who had less than 6-month gaps were 2.5 times as likely to delay getting urgent care. Children with gaps between 6 and 12 months or more than 12 months were 4.6 and 6.8 times, respectively, as likely to put off visits to receive urgent care.

The authors recommend that State policymakers design health insurance programs to prevent coverage gaps to ensure children receive continuous access to health care. This study was funded in part by the Agency for Healthcare Research and Quality (HS14645 and HS16181).

See "'Mind the gap' in children's health care coverage: Does the length of a child's coverage gap matter?" by Dr. DeVoe, Alan Graham, M.D., Lisa Krois, M.P.H., and others in the March-April 2008 Ambulatory Pediatrics 8(2), pp. 129-134.

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