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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
Article
  • 142 Downloads

Abstract

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.

Keywords

Health insurance Health care access Unmet health care needs Pediatric 

Notes

Compliance with Ethical Standards

Conflict of interest

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

References

  1. Barnett, M. L., Song, Z., Rose, S., Bitton, A., Chernew, M. E., & Landon, B. E. (2017). Insurance transitions and changes in physician and emergency department utilization: An observational study. Journal of General Internal Medicine, 32(10), 1146–1155.CrossRefGoogle Scholar
  2. Buchmueller, T., Orzol, S. M., & Shore-Sheppard, L. (2014). Stability of children’s insurance coverage and implications for access to care: Evidence from the survey of income and program participation. International Journal of Health Care Finance and Economics, 14(2), 109–126.CrossRefGoogle Scholar
  3. Burstin, H. R., Swartz, K., O’Neil, A. C., Orav, E. J., & Brennan, T. A. (1998). The effect of change of health insurance on access to care. Inquiry, 35(4), 389–397.Google Scholar
  4. Carroll, A., Corman, H., Curtis, M. A., Noonan, K., & Reichman, N. E. (2017). Housing instability and children’s health insurance gaps. Academic Pediatrics, 17(7), 732–738.CrossRefGoogle Scholar
  5. Chan, S. S., Gindling, T. H., & Miller, N. A. (2018). The effect of the Affordable Care Act’s dependent coverage provision on health insurance gaps for young adults with special healthcare needs. Journal of Adolescent Health.Google Scholar
  6. Clark, M. A., & Gurewich, D. (2017). Integrating measures of social determinants of health into health care encounters: Opportunities and challenges. Medical Care, 55(9), 807–809.CrossRefGoogle Scholar
  7. Guevara, J. P., Moon, J., Hines, E. M., Fremont, E., Wong, A., Forrest, C. B., et al. (2014). Continuity of public insurance coverage: A systematic review of the literature. Medical Care Research & Review, 71(2), 115–137.CrossRefGoogle Scholar
  8. Hudak, M. L., Helm, M. E., & White, P. H. & Committee on Child Health Financing. (2017). Principles of child health care financing. Pediatrics. 140(3), e20172098.CrossRefGoogle Scholar
  9. Knapp, E. A., Fink, A. K., Goss, C. H., Sewall, A., Ostrenga, J., Dowd, C., et al. (2016). The cystic fibrosis foundation patient registry. Design and methods of a national observational disease registry. Annals of the American Thoracic Society, 13(7), 1173–1179.CrossRefGoogle Scholar
  10. Larson, K., Cull, W. L., Racine, A. D., & Olson, L. M. (2016). Trends in access to health care services for us children: 2000–2014. Pediatrics, 138(6), e20162176.Google Scholar
  11. Leininger, L., & Levy, H. (2015). Child health and access to medical care. Future of Children, 25(1), 65–90.CrossRefGoogle Scholar
  12. McCullough, K., & Dalstrom, M. (2018). I am insured but how do i use my coverage: Lessons from the front lines of medicaid reform. Public Health Nursing.Google Scholar
  13. McManus, M. A., Pollack, L. R., Cooley, W. C., McAllister, J. W., Lotstein, D., Strickland, B., & Mann, M. Y. (2013). Current status of transition preparation among youth with special needs in the United States. Pediatrics, 131(6), 1090–1097.CrossRefGoogle Scholar
  14. National Center for Health Statistics. (2017a). National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm. Retrieved July 27, 2017.
  15. National Center for Health Statistics. (2017b). 2011 National Health Interview Survey (NHIS) public use data release: survey description. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2011/srvydesc.pdf Retrieved August 31, 2017.
  16. Okumura, M. J., Hersh, A. O., Hilton, J. F., & Lotstein, D. S. (2013). Change in health status and access to care in young adults with special health care needs: Results from the 2007 national survey of adult transition and health. Journal of Adolescent Health, 52(4), 413–418.CrossRefGoogle Scholar
  17. Olson, L. M., Tang, S. S., & Newacheck, P. W. (2005). Children in the United States with discontinuous health insurance coverage. New England Journal of Medicine, 353(4), 382–391.CrossRefGoogle Scholar
  18. Ortega, A. N., McKenna, R. M., Chen, J., Alcala, H. E., Langellier, B. A., & Roby, D. H. (2018). Insurance coverage and well-child visits improved for youth under the Affordable Care Act, but Latino youth still lag behind. Academic Pediatrics, 18(1), 35–42.CrossRefGoogle Scholar
  19. Orzol, S. M., Hula, L., & Harrington, M. (2015). Program churning and transfers between medicaid and CHIP. Academic Pediatrics, 15(3 Suppl.), S56–S63.CrossRefGoogle Scholar
  20. Parasuraman, S. R., Anglin, T. M., McLellan, S. E., Riley, C., & Mann, M. Y. (2018). Health care utilization and unmet need among youth with special health care needs. Journal of Adolescent Health.Google Scholar
  21. Sable, C., Foster, E., Uzark, K., Bjornsen, K., Cannobbio, M. M., & Connolly, H. M. … American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. (2011). Best practices in managing transition to adulthood for adolescents with congenital heart disease: The transition process and medical and psychosocial issues: A scientific statement from the American Heart Association. Circulation, 123(13), 1454–1485.CrossRefGoogle Scholar
  22. Satchell, M., & Pati, S. (2005). Insurance gaps among vulnerable children in the United States, 1999–2001. Pediatrics, 116(5), 1155–1161.CrossRefGoogle Scholar
  23. Schrager, S. M., Arthur, K. C., Nelson, J., Edwards, A. R., Murphy, J. M., Mangione-Smith, R., & Chen, A. Y. (2016). Development and validation of a method to identify children with social complexity risk factors. Pediatrics, 138(3), e20153787.CrossRefGoogle Scholar
  24. Smits-Seemann, R. R., Kaul, S., Hersh, A. O., Fluchel, M. N., Boucher, K. M., & Kirchhoff, A. C. (2016). ReCAP: Gaps in insurance coverage for pediatric patients with acute lymphoblastic leukemia. Journal of Oncology Practice, 12(2), 175–176.CrossRefGoogle Scholar
  25. Spencer, D. L., McManus, M., Call, K. T., Turner, J., Harwood, C., White, P., & Alarcon, G. (2018). Health care coverage and access among children, adolescents, and young adults, 2010–2016: Implications for future health reforms. Journal of Adolescent Health, 62(6), 667–673.CrossRefGoogle Scholar
  26. Strickland, B. B., Jones, J. R., Newacheck, P. W., Bethell, C. D., Blumberg, S. J., & Kogan, M. D. (2015). Assessing systems quality in a changing health care environment: The 2009-10 national survey of children with special health care needs. Maternal and Child Health Journal, 19(2), 353–361.CrossRefGoogle Scholar
  27. Torres, J. M., Lawlor, J., Colvin, J. D., Sills, M. R., Bettenhausen, J. L., Davidson, A., et al. (2017). ICD social codes: An underutilized resource for tracking social needs. Medical Care, 55(9), 810–816.CrossRefGoogle Scholar
  28. Tumin, D., King, A., Walia, H., Tobias, J. D., & Raman, V. T. (2017a). Discontinuous insurance coverage predicts prolonged hospital stay after pediatric adenotonsillectomy. Journal of Surgical Research, 218, 86–91.CrossRefGoogle Scholar
  29. Tumin, D., Li, S. S., Nandi, D., Gajarski, R. J., McKee, C., Tobias, J. D., & Hayes, D. Jr. (2017b). Health insurance coverage among young adult survivors of pediatric heart transplantation. Journal of Pediatrics, 188, 82–86.CrossRefGoogle Scholar
  30. Zan, H., & Scharff, R. L. (2015). The heterogeneity in financial and time burden of caregiving to children with chronic conditions. Maternal and Child Health Journal, 19(3), 615–625.CrossRefGoogle Scholar

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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