"Mind the Gap" in children's health insurance coverage: does the length of a child's coverage gap matter?
OBJECTIVE
Gaps in health insurance coverage compromise access to health care services, but it is unclear whether the length of time without coverage is an important factor. This article examines how coverage gaps of different lengths affect access to health care among low-income children.


METHODS
We conducted a multivariable, cross-sectional analysis of statewide primary data from families in Oregon's food stamp population with children presumed eligible for publicly funded health insurance. The key independent variable was length of a child's insurance coverage gap; outcome variables were 6 measures of health care access.


RESULTS
More than 25% of children reported a coverage gap during the 12-month study period. Children most likely to have a gap were older, Hispanic, lived in households earning between 133% and 185% of the federal poverty level, and/or had an employed parent. After adjusting for these characteristics, in comparison with continuously insured children, a child with a gap of any length had a higher likelihood of unmet medical, prescription, and dental needs; no usual source of care; no doctor visits in the past year; and delayed urgent care. When comparing coverage gaps, children without coverage for longer than 6 months had a higher likelihood of unmet needs compared with children with a gap shorter than 6 months. In some cases, children with gaps longer than 6 months were similar to, or worse off than, children who had never been insured.


CONCLUSIONS
State policies should be designed to minimize gaps in public health insurance coverage in order to ensure children's continuous access to necessary services.
DeVoe
Jennifer E
JE
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. devoej@ohsu.edu
Graham
Alan
A
Krois
Lisa
L
Smith
Jeanene
J
Fairbrother
Gerry L
GL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008483:Medical Assistance / Q000458:organization & administration*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009922:Oregon; D011203:Poverty; D013997:Time Factors