title: Being uninsured: impact on children's healthcare and health.
abstract: OBJECTIVE
  There are 8.4 million uninsured children in the United States. Many are eligible for coverage. Current literature on how lack of health insurance affects the quality and outcome of children's healthcare in the United States is reviewed, and effective solutions are identified. Recent policy changes have produced restrictions on basic preventive and curative services, despite concurrent major efforts to increase insurance coverage rates for children.
  
  
  RESULTS
  With more than 70% of currently uninsured children eligible for either Medicaid or the State Children's Health Insurance Program, these public programs have not yet produced expected levels of coverage. Health systems and provider accountability for the primary care of uninsured children is not optimal. Families of uninsured children face non-financial access barriers to care such as lack of continuity with a primary care provider and inadequate visit time. These barriers are compounded for uninsured children with special healthcare needs.
  
  
  CONCLUSIONS
  Pediatric primary care effectiveness is significantly reduced by insurance shortfalls. Lack of coverage inhibits appropriate care seeking; diminishes provider availability; compromises care content, quality, and satisfaction; and ultimately harms the entire family unit. However, provision of insurance alone is not a panacea.
authors.affiliation: Maternal and Child Health Team, National Center of Primary Care, Morehouse School of Medicine, Atlanta, Georgia 30310-1495, USA. yfry@msm.edu
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Fry-Johnson
authors.forename: Elvan C
authors.initials: EC
authors.lastname: Daniels
authors.forename: Robert
authors.initials: R
authors.lastname: Levine
authors.forename: George
authors.initials: G
authors.lastname: Rust
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000592:standards / Q000639:trends; D004632:Emergency Medical Services / Q000191:economics; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000639:trends; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D014481:United States