+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children's Health Insurance Program



Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children's Health Insurance Program



Pediatrics 120(4): E1009



The numbers and types of disruptions in insurance that children experience and the effects of these disruptions on health care measures have not been well characterized. Our goals were to (1) describe the number and patterns of insurance disruptions within a population of children newly enrolling into the State Children's Health Insurance Program and (2) assess the relationship among insurance disruptions and sociodemographic characteristics of these children and their families to specific measures of access to care, unmet need, and health care utilization during the year before enrollment. We conducted telephone interviews in families with children newly enrolling in the State Children's Health Insurance Program. Families reported on measures for each of the 12 months preceding enrollment. They were grouped by number of insurance disruptions in the year before enrollment: continuously uninsured, > or = 2 disruptions, 1 disruption, or continuously insured. Of 920 families contacted, 739 (80%) completed the interview and 710 had useable data. Thirty-five percent reported being continuously uninsured, 42% were intermittently insured (> or = 2 disruptions: 28%; 1 disruption: 14%), and 23% were continuously insured during the previous year. The most common patterns of change were between privately insured and uninsured (49%) and Medicaid and uninsured (40%). The continuously uninsured were more likely to be Hispanic and older in age. Multivariate modeling confirmed a gradient between greater insurance disruption and less access to care, less utilization, and greater unmet medical need. Using the continuously uninsured as a reference group, the adjusted odds ratio for having a medical home varied from 2.5 for those with > or = 2 disruptions to 4.5 for the continuously insured and from 1.9 to 3.2, respectively, for using any regular/routine care. The odds ratio for unmet need for a prescription medication was 0.9 for > or = 2 disruptions and 0.5 for those with continuous insurance coverage. There was significant disruption in insurance coverage in the year before State Children's Health Insurance Program enrollment. Most of these disruptions took the form of children previously enrolled in either Medicaid or private insurance becoming uninsured. Increasing numbers of disruptions were associated with less routine care and greater unmet medical need. These findings suggest that disruptions in insurance coverage for children should be minimized with the adoption of policies regarding continuous eligibility criteria for Medicaid and streamlining transitions between Medicaid, the State Children's Health Insurance Program, and private insurance.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 020874171

Download citation: RISBibTeXText

PMID: 17908722

DOI: 10.1542/peds.2006-3094


Related references

Adolescents who enroll in the state childrens health insurance program Access, utilization and quality of care during the year before SCHIP enrollment. Pediatric Research 53(4 Part 2): 4A, 2003

Improved access and quality of care after enrollment in the New York State Children's Health Insurance Program (SCHIP). Pediatrics 113(5): E395, 2004

The Effects of the State Childrens Health Insurance Program on Insurance Status and Health Care Utilization of Children. Journal of Family and Economic Issues 32(2): 373-383, 2011

Improvements in access to health care after enrollment in the State Childrens Health Insurance Program. Pediatric Research 53(4 Part 2): 263A, 2003

Reported changes in access, utilization and quality of health care one year after enrollment into a state child health insurance plan. Pediatric Research 51(4 Part 2): 172A, 2002

The impact of school enrollment-based health insurance on the State Children's Health Insurance Program (SCHIP). Journal of School Health 70(9): 381-384, 2000

Changes in access, utilization, and quality of care after enrollment into a state child health insurance plan. Pediatrics 115(2): 364-371, 2005

Coverage, utilization, and health outcomes of the State Children's Health Insurance Program. Inquiry 47(4): 296-314, 2011

Coverage, Utilization, and Health Outcomes of the State Children's Health Insurance Program. Inquiry - Journal of Health Care Organization, Provision and Financing 47(4): 296-314, 2010

Improved health care among children with special health care needs after enrollment into the State Children's Health Insurance Program. Ambulatory Pediatrics 7(1): 10-17, 2007

The effect of the State Children's Health Insurance Program on health insurance coverage. Journal of Health Economics 23(5): 1059-1082, 2004

Some answers to why the Childrens Health Insurance Program is not reaching enough uninsured children Barriers to health care access and insurance for Latino children. Pediatric Research. 49(4 Part 2): 467a, Il, 2001

Children's health insurance status, access to and utilization of health services, and unmet health needs in a rural Alabama school system. Journal of Rural Health 19(4): 511-513, 2003

Access to health insurance: State Children's Health Insurance Program. Issue brief. Issue Brief 2010: 1-35, 2010

Access to health Insurance: State Children's Health Insurance Program. Issue brief. Issue Brief: 1-22, 2011