The health and cost impact of care delay and the experimental impact of insurance on reducing delays

J Pediatr. 2009 Aug;155(2):281-5.e1. doi: 10.1016/j.jpeds.2009.02.035. Epub 2009 Apr 25.


Objective: To examine whether delays in seeking care are associated with worse health outcomes or increased treatment costs in children, and then assess whether insurance coverage reduces these delays.

Study design: We use data on 4070 children younger than 5 years from the Quality Improvement Demonstration Study, a randomized controlled experiment assessing the effects of increasing insurance coverage. We examined whether delay in care, defined as greater than 2 days between the onset of symptoms and admission to the study district hospitals, is associated with wasting or having positive C-reactive protein levels on discharge, and with total charge for hospital admission; we also evaluated whether increased benefit coverage and enrollment reduced the likelihood of delay.

Results: Delay is associated with 4.2% and 11.2% percentage point increases in the likelihood of wasting (P = .08) and having positive C-reactive protein levels (P = .03), respectively, at discharge. On average, hospitalization costs were 1.9% higher with delay (P = .04). Insurance intervention results in 5 additional children in 100 not delaying going to the hospital (P = .02).

Conclusions: In this population, delayed care is associated with worse health outcomes and higher costs. Access to insurance reduced delays; thus insurance interventions may have positive effects on health outcomes.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • C-Reactive Protein / analysis
  • Child, Preschool
  • Diarrhea / epidemiology
  • Educational Status
  • Health Status
  • Hospital Costs
  • Hospitalization / economics
  • Humans
  • Income
  • Infant
  • Insurance Coverage*
  • Insurance, Health*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Pneumonia / epidemiology
  • Severity of Illness Index
  • Time Factors
  • Wasting Syndrome / epidemiology


  • C-Reactive Protein