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When Insurance Status Is Not Static: Insurance Transitions of Low-Income Children and Implications for Health and Health Care

      Objectives.—Among low-income children, to characterize the frequency of transitions in health insurance coverage and examine associations of transitions with health status and health care access.
      Methods.—Data from the 1999 National Survey of America's Families were used in weighted analyses to identify sociodemographic characteristics associated with health insurance transitions for children living in households with income <200% of the federal poverty level over the preceding 12 months. In logistic regression models, we examined associations of insurance transitions with children's health status (fair/poor health), postponement of children's medical care or prescription medications, and lack of physician visits.
      Results.—Among 27.93 million low-income children in 1999, 5.7 million (20.4%) had experienced an insurance transition in the preceding year. Non-Hispanic black children (24.5%) and children whose parents did not have a partner or spouse (23.5%) were significantly more likely than other children to have experienced transitions. Hispanic children (16%) were least likely to have experienced transitions. Compared with children with continuous private coverage, children who had transitioned from public to private coverage were more likely to report fair or poor health, children who experienced transitions that included a period of no coverage were more likely to report postponed medical care and prescription drugs, and children who experienced a no-coverage-to-private-coverage transition were more likely to have foregone physician visits.
      Conclusion.—Transitions in insurance coverage affect many low-income children and may represent barriers to their health care. Considering insurance transitions may provide a more complete picture of children's health and health care utilization.

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      REFERENCES

        • Szilagyi PG
        • Schor EL
        The health of children.
        Health Serv Res. 1998; 33: 1001-1039
        • Dubay L
        • Kenney GM
        Health care access and use among low-income children: who fares best?.
        Health Aff. 2001; 20: 112-121
        • Lave J
        • Keane C
        • Lin C
        • et al.
        Impact of a children's health insurance program on newly enrolled children.
        JAMA. 1998; 279: 1820-1825
        • Newacheck P
        • Stoddard J
        • Hughes D
        • Pearl M
        Health insurance and access to primary care for children.
        N Engl J Med. 1998; 338: 513-519
        • Elixhauser A
        • Machlin SR
        • Zodet MW
        • et al.
        Health care for children and youth in the United States: 2001 annual report on access, utilization, quality, and expenditures.
        Ambul Pediatr. 2002; 2: 419-437
        • Newacheck P
        • Brindis C
        • Cart C
        • et al.
        Adolescent health insurance coverage: recent changes and access to care.
        Pediatrics. 1999; 104: 195-202
        • Simpson L
        • Fraser I
        Children and managed care: what research can, can't, and should tell us about impact.
        Med Care Res Rev. 1999; 56: 13-36
        • Zuckerman S
        • Kenney GM
        • Dubay L
        • et al.
        Shifting health insurance coverage, 1997–1999.
        Health Aff. 2001; 20: 169-177
        • Holahan J
        • Pohl M
        Changes in insurance coverage: 1994–2000 and beyond.
        Health Aff. 2002; : W162-W171
        • Garrett B
        • Holahan J
        Health insurance coverage after welfare.
        Health Aff. 2000; 19: 175-184
        • Short PF
        • Lair TJ
        Health insurance and health status: implications for financing health care reform.
        Inquiry. 1994/95; 31: 425-437
        • Kogan MD
        • Alexander GR
        • Teitelbaum MA
        • et al.
        The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States.
        JAMA. 1995; 274: 1429-1435
        • Tang
        • S-f S
        • Olson LM
        • Yudkowsky BK
        Uninsured children: how we count matters.
        Pediatrics. 2003; 112: e168
        • Urban Institute.
        Assessing the New Federalism.
        (Accessed January 27, 2004.)
        • Haley J
        • Kenney G
        Coverage gaps for Medicaid-eligible children in the wake of federal welfare reform.
        Inquiry. 2003; 40: 158-168
        • Long SK
        • Coughlin TA
        Access and use by children on Medicaid: does state matter?.
        Inquiry. 2001/02; 38: 409-422
        • Urban Institute.
        Assessing the New Federalism.
        (Accessed January 27, 2004.)
        • Safir A
        • Scheuren F
        • Wang K
        National Survey of America's Families: survey methods and data reliability, 1997 and 1999. Urban Institute.
        (Accessed January 27, 2004.)