title: ReCAP: Gaps in Insurance Coverage for Pediatric Patients With Acute Lymphoblastic Leukemia.
abstract: OBJECTIVE
  Continuous insurance coverage is an important component of effective health care. Evaluation of insurance gaps in pediatric cancer care is an understudied area.
  
  
  METHODS
  We conducted a retrospective analysis of payer data from outpatient oncology encounters at Primary Children's Hospital (Salt Lake City, UT) over the first 2 years of therapy for pediatric patients with acute lymphoblastic leukemia diagnosed from 1998 to 2010 (N = 380). Using logistic regression, we evaluated demographic and clinical predictors (age at diagnosis, sex, ethnicity, high/standard acute lymphoblastic leukemia risk, and rural/urban county of residence at diagnosis) of a gap in health insurance.
  
  
  RESULTS
  The median age at diagnosis was 4 years (interquartile range, 3 to 8 years), and 172 patients (45%) were girls. In the first 2 years of treatment, 45 patients (12%) experienced a gap in health insurance. The odds of having a gap in insurance coverage decreased by 16% each year from 1998 to 2010 (odds ratio, 0.84; 95% CI, 0.76 to 0.93; test for trend, P = .001). Public insurance at diagnosis was associated with a four-fold increased likelihood of experiencing an insurance gap (odds ratio, 4.09; 95% CI, 1.98 to 8.44; P < .001) compared with patients with private insurance at diagnosis.
  
  
  CONCLUSIONS
  Gaps in insurance coverage during pediatric cancer treatment are not uncommon, which highlights the importance of discussing insurance status at diagnosis and throughout a patient's treatment course to help patients and their families prepare for any changes and avoid unnecessary financial burden. Future research should focus on examining the effect of insurance gaps on patient outcomes and evaluating likelihood of gaps in insurance after health care reform.
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT rochelle.smits@hci.utah.edu.
authors.forename: Rochelle R
authors.initials: RR
authors.lastname: Smits-Seemann
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Sapna
authors.initials: S
authors.lastname: Kaul
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Aimee O
authors.initials: AO
authors.lastname: Hersh
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Fluchel
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT rochelle.smits@hci.utah.edu.
authors.forename: Rochelle R
authors.initials: RR
authors.lastname: Smits-Seemann
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Sapna
authors.initials: S
authors.lastname: Kaul
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Aimee O
authors.initials: AO
authors.lastname: Hersh
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Fluchel
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.affiliation: University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014589:Utah / Q000453:epidemiology / Q000208:ethnology