Maternal and Child Health Journal

, Volume 23, Issue 5, pp 667–677 | Cite as

Patterns of Health Insurance Discontinuity and Children’s Access to Health Care

  • Dmitry TuminEmail author
  • Rebecca Miller
  • Vidya T. Raman
  • Joshua C. Uffman
  • Joseph D. Tobias


Objectives This study classified patterns of discontinuous health insurance coverage, including change in coverage type and gaps in coverage, and described their associations with children’s access to health care. Methods Using the 2011–2013 National Health Interview Survey data, we determined children’s insurance coverage over the past year, and whether children had a usual source of care, had to delay getting care, or had unmet health care needs. Using multivariable logistic regression, we compared measures of access to care across insurance coverage patterns, classified as continuous private coverage; continuous public coverage; continuous lack of coverage; change in coverage type (public versus private) without gaps in coverage; and any gap in coverage. A subgroup analysis repeated this comparison for children with a caregiver-reported chronic physical illness. Results The analysis included 34,105 children, of whom 7% had a gap in coverage and 1% had a change in coverage type. On multivariable analysis, gaps in coverage were associated with increased likelihood of unmet health care needs, compared to continuous private (OR 6.9; 95% CI 5.9, 8.0) or continuous public coverage (OR 5.1; 95% CI 4.4, 6.0). Seamless changes in coverage were also associated with greater likelihood of unmet health care needs [OR vs. private: 3.8 (95% CI 2.3, 6.1); OR vs. public: 2.8 (95% CI 1.8, 4.6); all p < 0.001]. Results were similar for other study outcomes, and among children with chronic physical illness. Conclusions for Practice Both gaps in coverage and seamless changes between coverage types were associated with limited health care access for children.


Health insurance Health care access Unmet health care needs Pediatric 


Compliance with Ethical Standards

Conflict of interest

No potential conflicts of interests exist for any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Dmitry Tumin
    • 1
    • 2
    • 4
    Email author
  • Rebecca Miller
    • 1
  • Vidya T. Raman
    • 1
    • 3
  • Joshua C. Uffman
    • 1
    • 3
  • Joseph D. Tobias
    • 1
    • 3
  1. 1.Department of Anesthesiology and Pain MedicineNationwide Children’s HospitalColumbusUSA
  2. 2.Department of PediatricsThe Ohio State University College of MedicineColumbusUSA
  3. 3.Department of AnesthesiologyThe Ohio State University College of MedicineColumbusUSA
  4. 4.Department of Pediatrics, Brody School of MedicineEast Carolina UniversityGreenvilleUSA

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