The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States

Abstract

<h3>Objective.</h3> —To estimate the prevalence and length of gaps in health insurance coverage and their effect on having a regular source of care in a national sample of preschool-aged children. <h3>Design.</h3> —Follow-up survey of a nationally representative sample of 3-year-old children in the US population by phone or personal interview. <h3>Participants.</h3> —A total of 8129 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey. <h3>Main Outcome Measures.</h3> —Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the children were taken for medical care as a measure of continuity of a regular source of care. <h3>Results.</h3> —About one quarter of US children were without health insurance for at least 1 month during their first 3 years of life. Over half of these children had a health insurance gap of more than 6 months. Less than half of US children had only one site of care during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one care site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). This risk further increased when an emergency treatment was discounted as a multiple site of care. <h3>Conclusions.</h3> —Having a gap in health insurance coverage is an important determinant for not having a regular source of care for preschool-aged children. This finding is of concern, given the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of development. (<i>JAMA</i>. 1995;274:1429-1435)