The impact of insurance instability on children's access, utilization, and satisfaction with health care.

OBJECTIVES: We describe instability of health insurance coverage for children aged 2 to 17 years and relate insurance instability to access, utilization and satisfaction.

METHODS: Three 2-year panels of the Medical Expenditure Panel Survey were used to measure insurance instability and its relationship to access, utilization, and problems with medical care.

RESULTS: Over a 2-year period, 53% of children were continuously insured with private coverage, 19% had continuous public insurance, 20% had a single gap in coverage, 2% had multiple gaps, and 6% were continuously uninsured. Compared with children continuously insured through private coverage, children with single or multiple gaps or who were continuously uninsured were significantly more likely to lack a usual source of care (adjusted odds ratios [AORs] = 2.3, 3.5, and 4.5, respectively), to have no well-child visits (AORs = 1.2, 2.2 and 2.4, respectively), and to have unmet medical or prescription drug needs (AORs = 4.5, 4.2 and 3.4, respectively). There were no significant differences between children continuously insured through private coverage and children with single or multiple gaps or continuously uninsured and having at least 1 problem with medical care (AORs = 0.8, 1.3, and 1.4, respectively). While there were no differences between children continuously insured through private coverage and children with multiple gaps or continuously uninsured, children with single gap in coverage were significantly more likely to report having at least one problem with medical care (AOR = 1.5).

CONCLUSIONS: Compared with those with continuous coverage, children with gaps in coverage--especially those with multiple gaps--are less likely to have a usual source of care and receive well-child care. The national debate should incorporate discussions of policies to promote not only expansions of coverage, but also initiatives to eliminate gaps in coverage.