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November 8, 1995

The Effect of Gaps in Health Insurance on Continuity of a Regular Source of Care Among Preschool-aged Children in the United States

Author Affiliations

From the Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md (Drs Kogan and Pappas); Department of Maternal and Child Health, University of Alabama at Birmingham (Dr Alexander); Children's Defense Fund, Washington, DC (Dr Teitelbaum); Department of Family Medicine, Brown University School of Medicine, Providence, RI (Dr Jack); and Maternal and Child Health Department, University of North Carolina at Chapel Hill (Dr Kotelchuck).

JAMA. 1995;274(18):1429-1435. doi:10.1001/jama.1995.03530180023025

Objective.  —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.

Design.  —Follow-up survey of a nationally representative sample of 3-year-old children in the US population by phone or personal interview.

Participants.  —A total of 8129 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey.

Main Outcome Measures.  —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.

Results.  —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.

Conclusions.  —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.(JAMA. 1995;274:1429-1435)