Underinsurance among Children in the United States
Open accessAbstract
BACKGROUND: Recent interest in policy regarding children's health insurance has focused on expanding coverage. Less attention has been devoted to the question of whether insurance sufficiently meets children's needs. METHODS: We estimated underinsurance among U.S. children on the basis of data from the 2007 National Survey of Children's Health (sample size, 91,642 children) regarding parents' or guardians' judgments of whether their children's insurance covered needed services and providers and reasonably covered costs. Data on adequacy were combined with data on continuity of insurance coverage to classify children as never insured during the past year, sometimes insured during the past year, continuously insured but inadequately covered (i.e., underinsured), and continuously insured and adequately covered. We examined the association between this classification and five overall indicators of health care access and quality: delayed or forgone care, difficulty obtaining needed care from a specialist, no preventive care, no developmental screening at a preventive visit, and care not meeting the criteria of a medical home. RESULTS: We estimated that in 2007, 11 million children were without health insurance for all or part of the year, and 22.7% of children with continuous insurance coverage--14.1 million children--were underinsured. Older children, Hispanic children, children in fair or poor health, and children with special health care needs were more likely to be underinsured. As compared with children who were continuously and adequately insured, uninsured and underinsured children were more likely to have problems with health care access and quality. CONCLUSIONS: The number of underinsured children exceeded the number of children without insurance for all or part of the year studied. Access to health care and the quality of health care are suboptimal for uninsured and underinsured children. (Funded by the Health Resources and Services Administration.)
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Subsequent audit studies did not sufficiently examine physicians' willingness to provide needed specialty care for publicly insured children.
“Subsequent studies in which this approach was used did not sufficiently examine physicians' willingness to provide needed specialty care for publicly insured children.7,13,21,22”
From Auditing Access to Specialty Care for Children with Public Insurance (2011) · cites this paper as [21]
The Abstract and Measurement of Insurance Adequacy section describe a survey-based analysis of children’s insurance and access to specialist care, not an audit study. The paper does not measure physicians’ willingness to treat publicly insured children, but it cannot substantiate the claim about subsequent audit studies as a group. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSample-size calculations before the study indicated that 20 clinics would provide 80% power to detect a 34% difference and 32 clinics would be needed to detect a 20% difference in the rate of clinics accepting public versus private insurance, at an alpha level of 0.05.
“Sample-size calculations for McNemar's test before the study were based on previous data from audit studies.21 We calculated that a sample of 20 clinics would provide 80% power to detect a 34% difference and that 32 clinics would be needed to detect a 20% difference in the rate of clinics accepting public versus private insurance, at an alpha level of 0.05.”
From Auditing Access to Specialty Care for Children with Public Insurance (2011) · cites this paper as [21]
The citation is attached to the statement that the sample-size calculations used previous audit-study data; the following sentence presents the power calculations as the citing authors’ own. The cited paper’s Statistical Analysis section describes analyses of a national survey of children, not an audit of clinics, and our copy provides no audit-study data or clinic sample-size calculations (searched for McNemar’s test, clinic acceptance, and the stated power figures). (LLM, conf=0.76)
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References 26 · Cited by 120
Research works printed but not linked: 21
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- Authors
- Kogan, M. D., Newacheck, P. W., Blumberg, S. J., Ghandour, R. M., Singh, G. K., Strickland, B. B., & van Dyck, P. C.
- Affiliations
- Health Resources and Services Administration (US)
- University of California, San Francisco (US)
- Centers for Disease Control and Prevention (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-08-26
- Volume
- 363
- Issue
- 9
- Pages
- 841-851
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2093768316
- Cited by
- 120
- References
- 26
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 1 · 2019: 3 · 2018: 12 · 2017: 3 · 2016: 8 · 2015: 9 · 2014: 13 · 2013: 11 · 2012: 19
- FWCI
- 34.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- underinsurance, children's health insurance, health insurance coverage, health care access, quality of care, preventive medicine, developmental screening, patient-centered medical home, access to specialist care, special health care needs, Hispanic children, National Survey of Children's Health
- MeSH terms
- Adolescent, Child, Child, Preschool, Costs and Cost Analysis, Delivery of Health Care, Female, Health Services Accessibility, Humans, Infant, Insurance, Health, Male, United States, Logistic Models, Odds Ratio, Medically Uninsured, Insurance Coverage, Health Care Surveys
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