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America's Children in Brief: Key National Indicators of Well-Being, 2018

Health Insurance Continuity

Health insurance is a major determinant of access to health care.7, 8 Lack of insurance coverage is associated with lower access to and utilization of care.8, 9, 10, 11 Children without insurance coverage are less likely to have a usual source of care and are less likely to use physician services than those with continuous coverage, thus reducing their continuity of care.9, 11 They are also more likely to experience long wait times and delays in getting needed care.9, 11 Children and adolescents need regular health care to obtain routine preventive care, health and developmental guidance, screening for health conditions, treatment of acute and chronic conditions, and injury care.12 Delaying or skipping needed care can lead to additional health problems, such as increased likelihood of hospitalization for avoidable conditions.7

Brief uninsured periods are associated with decreased access to and utilization of health care services. Children with longer periods without insurance are even less likely to visit the doctor during the year; less likely to receive preventive care, such as well-child visits and flu shots; and more likely to experience delays in receiving needed medical care and prescriptions than those with continuous coverage.9, 10, 11, 13

Chronic uninsurance is defined as being uninsured for 1 year or more.

Figure 2: Health insurance coverage among children ages 0–17 by health insurance duration, 2005–2006 through 2015–2016
Health insurance coverage among children ages 0–17 by health insurance duration, 2005–2006 through 2015–2016

NOTE: Data are for the civilian noninstitutionalized population. Chronically uninsured is defined as those without insurance for 1 year or more.

SOURCE: National Center for Health Statistics, National Health Interview Survey.

  • The percentage of children chronically uninsured declined from 5 percent in 2005–2006 to 2 percent in 2015–2016.
  • The percentage of children uninsured for up to 12 months declined from 2009–2010 (7 percent) through 2015–2016 (5 percent), after being stable from 2005–2006 to 2009–2010.
  • The percentage of children insured continuously for the past 12 months was stable from 2005–2006 to 2007–2008, then increased from 88 percent in 2009–2010 to 93 percent in 2015–2016.

Figure 3: Percentage of children ages 0–17 who delayed or did not receive medical care or had no health care visits in the past 12 months by health insurance duration, 2015–2016
Percentage of children ages 0–17 who delayed or did not receive medical care or had no health care visits in the past 12 months by health insurance duration, 2015–2016

NOTE: Data are for the civilian noninstitutionalized population. Chronically uninsured is defined as those without insurance for 1 year or more. Visits to emergency rooms, hospitalizations, home visits, dental offices, and telephone calls are excluded.

SOURCE: National Center for Health Statistics, National Health Interview Survey.

  • During 2015–2016, the percentage of children with an unmet need for medical care due to cost was higher for both the chronically uninsured and those uninsured for any period up to 12 months compared with children insured continuously for the past 12 months.
  • Forty-two percent of children chronically uninsured (that is, uninsured for more than a year) had no health care visits in the past 12 months. In contrast, 14 percent of children uninsured for up to 12 months and 7 percent of children with insurance for all 12 months had no health care visits.

table icon BRIEF2 HTML Table,  BRIEF3 HTML Table

7 Rosenbaum, S., & Kenney, G. M. (2014). The search for a national child health coverage policy. Health Affairs (Millwood), 33(12), 2125–2135.

8 National Center for Health Statistics. (2017). Health, United States, 2016, with chartbook on long-term trends in health. Hyattsville, MD: Author.

9 DeVoe, J. E., Ray, M., Krois, L., & Carlson, M. J. (2010). Uncertain health insurance coverage and unmet children's health care needs. Family Medicine, 42(2),121–132.

10 Federico, S. G., Steiner, J. F., Beaty, B., Crane, L., & Kempe, A. (2007). Disruptions in insurance coverage: Patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children's Health Insurance Program. Pediatrics, 120(4), e1009–1016.

11 Cummings, J. R., Lavarreda, S. A., Rice, T., & Brown, E. R. (2009). The effects of varying periods of uninsurance on children's access to health care. Pediatrics, 123(3), e411–418.

12 American Academy of Pediatrics. (2016). 2016 recommendations for preventive pediatric healthcare. Pediatrics, 137(1), 25–27.

13 Hill, H. D., & Shaefer, H. L. (2011). Covered today, sick tomorrow? Trends and correlates of children's health insurance instability. Medical Care Research and Review, 68(5), 523–536.