The effects of varying periods of uninsurance on children's access to health care.
OBJECTIVE
Many studies have documented the adverse consequences of uninsurance for children, but less is known about the differential effects of varying periods of uninsurance. This study examines the relative effects of varying periods of uninsurance (uninsured for 1-4 months, 5-11 months, or all year) on children's access to care.


METHODS
Using data from the 2005 California Health Interview Survey Children's File (ages 0-11), we estimated logistic regressions to examine the effect of insurance status on 6 measures of health care access, controlling for child demographics, child health status, family characteristics, and urban residence. Indicators for insurance status included the following categories: (1) privately insured all year (reference); (2) Medicaid all year; (3) State Children's Health Insurance Program all year; (4) uninsured for 1 to 4 months; (5) uninsured for 5 to 11 months; (6) uninsured all year; and (7) other insurance all year.


RESULTS
We found that children who experience short spells of uninsurance (1-4 months) are less likely to have a usual source of care and are more likely to experience delays in needed care than those with continuous private or public insurance. The consequences are even worse for children who experience more substantial periods of uninsurance, because they are also less likely to receive preventive care (well-child visits and flu shots) or visit the doctor during the year and are more likely to experience delays in receiving needed medical care and prescriptions than those with continuous coverage. The Medicaid program and State Children's Health Insurance Program in California both seem to have ensured levels of health care access similar to that obtained by children with year-round private coverage.


CONCLUSIONS
These findings highlight the benefits gained through continuous health insurance, whether public or private. Public policies should be adopted to ensure continuity of coverage and retention in public insurance programs.
Cummings
Janet R
JR
BA, Department of Health Services, School of Public Health, Campus Box 951772, Los Angeles, CA 90095-1772, USA. jrc12@ucla.edu
Lavarreda
Shana Alex
SA
Rice
Thomas
T
Brown
E Richard
ER
D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D055553:Prescription Drugs; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012044:Regression Analysis; D013221:State Health Plans / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States
D055553:Prescription Drugs