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 Nov 8;274(18):1429-35.


Objective: To estimate the prevalence and length of gaps in health insurance coverage and their effect on having a regular source of care in a national sample of preschool-aged children.

Design: Follow-up survey of a nationally representative sample of 3-year-old children in the US population by phone or personal interview.

Participants: A total of 8129 children whose mothers were interviewed for the 1991 longitudinal Follow-up to the National Maternal and infant Health Survey.

Main outcome measures: Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the children were taken for medical care as a measure of continuity of a regular source of care.

Results: About one quarter of Us children were without health insurance for at least 1 month during their first 3 years of life. Over half of these children had a health insurance gap of more than 6 months. Less than half of US children had only one site of care during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one care site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). This risk further increased when an emergency treatment was discounted as a multiple site of care.

Conclusions: Having a gap in health insurance coverage is an important determinant for not having a regular source of care for preschool-aged children. This finding is of concern, given the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of development.

MeSH terms

  • Child Health Services / economics*
  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Continuity of Patient Care / economics*
  • Continuity of Patient Care / statistics & numerical data
  • Humans
  • Infant
  • Insurance, Health / statistics & numerical data*
  • Logistic Models
  • Longitudinal Studies
  • Medically Uninsured / statistics & numerical data*
  • Multivariate Analysis
  • Population Surveillance
  • Socioeconomic Factors
  • United States / epidemiology