Freedom's Fire, Brightly Burning

Associated Press
Updated: 6:06 p.m. ET July 27, 2005

For every child who lacks health insurance, another has gaps in coverage and is just as likely to miss out on seeing a doctor or getting a prescription refilled, suggests a new comprehensive study of federal data.

The research also reveals some surprises: About four out of five children with insurance coverage gaps have parents who work; two-thirds of them live with both parents; and more than half are white.

At least 9 million U.S. children, or about 12 percent, lack health insurance, based on a federal survey in 2003. Researchers who produced the latest study say that number is likely higher because many kids who lack health insurance during part of their childhood aren’t included in that number.

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Results During the last 12 months before they were interviewed, 6.6 percent of children in the United States had no insurance and an additional 7.7 percent had gaps in insurance. Children who had full-year insurance coverage (private or public) had low rates of unmet health care needs and good access to care (delayed care, unmet medical care, and unfilled prescriptions were reported in <3 percent, and <5 percent had no usual place of care). Access to care was much worse for children who were uninsured for part of the year and for those who were uninsured for the full year (delayed care, 20.2 percent and 15.9 percent, respectively; unmet medical care, 13.4 percent and 12.6 percent, respectively; unfilled prescriptions, 9.9 percent and 10.0 percent, respectively; P<0.01 for all comparisons with children with full-year, private insurance coverage). In multivariate analyses adjusting for age, income, race or ethnic group, region, citizenship, family structure, parental employment, and health status, the differences in access to care persisted. As compared with the parents of children with full-year, private insurance, parents of children uninsured for the full year were far more likely to report delaying care (adjusted odds ratio, 12.65; 95 percent confidence interval, 9.45 to 16.94), as were parents of children uninsured for part of the year (adjusted odds ratio, 13.65; 95 percent confidence interval, 10.41 to 17.90).

Conclusions Children with gaps in health insurance coverage commonly do not seek medical care, including preventive visits, and do not get prescriptions filled. These findings are important for both research and policy and point to the need for more encompassing and sensitive measures of the situation of being uninsured.