The impact of health insurance gaps on access to care among children with asthma in the United States.
BACKGROUND
Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers.


OBJECTIVE
The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma.


METHODS
The National Survey of Children's Health provided parent-report data for 8097 children with asthma. We identified children with continuous public or continuous private insurance and defined 3 groups with gaps in insurance coverage: those currently insured who had a lapse in coverage during the prior 12 months (gained insurance), those currently uninsured who had been insured at some time during the prior 12 months (lost insurance), and those with no health insurance at all during the prior 12 months (full-year uninsured).


RESULTS
Thirteen percent of children had coverage gaps (7% gained insurance, 4% lost insurance, and 2% were full-year uninsured). Many children with gaps in coverage had unmet needs for care (7.4%, 12.8%, and 15.1% among the gained insurance, lost insurance, and full-year uninsured groups, respectively). In multivariate models, we found significant associations between insurance gaps and every indicator of poor access to care among this population.


CONCLUSIONS
Many children with asthma have unmet health care needs and poor access to consistent primary care, and lack of continuous health insurance coverage may play an important role. Efforts are needed to ensure uninterrupted coverage for these children.
Halterman
Jill S
JS
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Strong Children's Research Center, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Montes
Guillermo
G
Shone
Laura P
LP
Szilagyi
Peter G
PG
D000293:Adolescent; D001249:Asthma / Q000191:economics* / Q000517:prevention & control; D002648:Child; D002662:Child Health Services / Q000191:economics*; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008489:Medical Indigency; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000191:economics; D014481:United States