title: Switching health insurance and its effects on access to physician services.
abstract: BACKGROUND
  This study examines the factors associated with discontinuous health insurance coverage without periods of uninsurance during the past year (ie, switching coverage), and whether it has a detrimental effect on basic access to care.
  
  
  METHODS
  We analyze the 2003 California Health Interview Survey samples of adults, ages 19-64 (n = 32,850) and children, ages 0-18 (n = 13,062), using weighted bivariate and multivariate analyses. We stratified the population first by age (modeling adults separately from children) and then by health status (modeling the full population and the population reporting fair or poor health separately).
  
  
  RESULTS
  Income, race/ethnicity, age, gender, and rural status were significant factors associated with switching coverage. Adults who switched insurance had significantly reduced odds of having a usual source of care [odds ratio (OR) = 0.63, P < 0.001)] compared with those with continuous coverage. In addition, adults and children who switched coverage were significantly more likely to report delaying care because of cost or insurance issues (adults: OR = 1.65, P < 0.001; children: OR = 2.00, P < 0.001). Children in fair or poor health who switched insurance coverage had much higher odds of reporting a delay in care (OR = 5.48, P < 0.001).
  
  
  CONCLUSIONS
  Children and adults had disruptions in their basic access to health care when they experienced discontinuous insurance. These findings highlight the advantages of retention of enrollees as one means of promoting access to health care, in the short term, and the benefit of a continuous national health insurance program in the long term.
authors.affiliation: UCLA Center for Health Policy Research, Los Angeles, California 90024, USA.
authors.forename: Shana Alex
authors.initials: SA
authors.lastname: Lavarreda
authors.forename: Melissa
authors.initials: M
authors.lastname: Gatchell
authors.forename: Ninez
authors.initials: N
authors.lastname: Ponce
authors.forename: E Richard
authors.initials: ER
authors.lastname: Brown
authors.forename: Y Jenny
authors.initials: YJ
authors.lastname: Chia
mesh_terms: D000328:Adult; D002140:California; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000145:classification; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data; D012959:Socioeconomic Factors