title: Continuity of health insurance coverage for children with special health care needs.
abstract: OBJECTIVE
  To assess the continuity of health insurance coverage and its associated factors for children with special health care needs (CSHCN).
  
  
  METHODS
  Logistic regression and proportional hazard models were estimated on monthly insurance enrollment for 5594 children in the 1996 Medical Expenditure Panel Survey. CSHCN were identified using a non-categorical approach. Stratified analyses were conducted to determine whether any characteristics differentiated the effects of CSHCN status on children's coverage.
  
  
  RESULTS
  In 1996, more than 8% of CSHCN were uninsured for the entire year. For those who were insured in January 1996, 14% lost their coverage by December 1996. CSHCN were more likely than other children to be insured (92% vs. 89%), mainly due to their better access to public insurance (35% vs. 23%). Conversely, CSHCN were less likely than other children to stay insured if they were school-aged, non-Hispanic White, from working, low-income families or the US Midwest region. Higher parental education improved health insurance enrollment for CSHCN, whereas higher family income or having activity limitations protected them from losing coverage. Regardless of CSHCN status, being publicly insured was associated with a higher risk of losing coverage for children.
  
  
  CONCLUSIONS
  Despite increased health care needs, a considerable proportion of CSHCN is unable to access or maintain coverage. Compared to other children, CSHCN are more likely to have coverage but no more likely to stay insured. Improving continuity of coverage for publicly insured children is needed, especially CSHCN who are more likely to obtain their coverage through public programs.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA. liu_chialing@yahoo.com
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Liu
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ganz
authors.forename: James
authors.initials: J
authors.lastname: Perrin
authors.forename: Steven
authors.initials: S
authors.lastname: Gortmaker
authors.forename: Marie C
authors.initials: MC
authors.lastname: McCormick
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000458:organization & administration*; D007348:Insurance, Health; D016015:Logistic Models; D017150:Public Sector