PROFILE OF UNINSURED CHILDREN IN THE UNITED-STATES

Objectives: To describe the demographic characteristics, utilization o f medical services, and health status of uninsured children compared w ith insured children in the United States and to assess the factors as sociated with lack of health insurance among children. An estimated 8 million children in the United States are uninsured. Medicaid expansio ns and tax credits have had little impact on the overall problem. An u nderstanding of the characteristics of uninsured children is essential for the design of appropriate outreach and enrollment strategies, ben efit packages, and health care provision arrangements for uninsured ch ildren. Methods: Analysis of the 1988 Child Health Supplement of the N ational Health Interview Survey. Results: Diverse groups of children i n the United States lack health insurance. Residence in the South (odd s ratio [OR], 2.3) and West (OR, 1.9.1) and being poor (OR, 2.2) or ne arly poor (OR, 2.1) are independently associated with being uninsured. Substantial differences in both sources of care and utilization of me dical services exist between uninsured and insured children. Uninsured children lack usual sources of routine care (OR, 3.1) and sick care ( OR, 3.8) and also lack appropriate well-child care (OR, 1.5) compared with insured children. Neither being in fair or poor health nor emerge ncy department use are significant independent predictors of being uni nsured among children. Children who have a chronic disease, such as as thma, face difficulties of access to care and utilize substantially fe wer outpatient and inpatient services. Conclusions: Universal health i nsurance, rather than efforts directed at specific groups, appears to be the only way to provide health insurance for all US children. Unins ured and insured children reveal marked discrepancies in access to and utilization of medical services, including preventive services, but h ave similar rates of chronic health conditions and limitation of activ ity. Uninsured children do not appear to form a population that will i ncur higher mean annual expenditures for medical care compared with in sured children.