THE EFFECT OF GAPS IN HEALTH-INSURANCE ON CONTINUITY OF A REGULAR SOURCE OF CARE AMONG PRESCHOOL-AGED CHILDREN IN THE UNITED-STATES

Objective.-To estimate the prevalence and length of gaps in health ins urance coverage and their effect on having a regular source of care in a national sample of preschool-aged children. Design.-Follow-up surve y 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 Longitudina l Follow-up to the National Maternal and Infant Health Survey.Main Out come Measures.-Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the ch ildren were taken for medical care as a measure of continuity of a reg ular source of care. Results.-About one quarter of US children were wi thout 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 mo re than 6 months. Less than half of US children had only one site of c are during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one c are site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). T his risk further increased when an emergency treatment was discounted as a multiple site of care. Conclusions.-Having a gap in health insura nce coverage is an important determinant for not having a regular sour ce of care for preschool-aged children. This finding is of concern, gi ven the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of developme nt.