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December 23, 1992

Uninsured Children and National Health Reform

Author Affiliations

From the Department of Social Policy, RAND, Washington, DC.

JAMA. 1992;268(24):3473-3477. doi:10.1001/jama.1992.03490240081042

THE HEALTH of the nation's children and their access to care has received renewed public policy attention in recent years. A special policy focus on children derives in part from evidence of the cost-effectiveness of preventive and primary care for children.1 However, lack of health insurance poses a significant financial barrier to the receipt of the recommended levels of preventive care, especially for poor children. An increase in the share of the cost of health care the family has to pay out-of-pocket is associated with a decrease in immunizations for all children less than age 7 years and a decrease in the likelihood of having a general medical examination and a vision examination among poor children.2,3 Increased patient cost-sharing also deters poor families from seeking ambulatory care for children for acute problems for which medical advice is highly effective, such as otitis media, "strep throat," lacerations, and fractures.3