The impact of a children's health insurance program by age

Objectives. 1) To examine age variation in unmet need/delayed care, access, utilization, and restricted activities attributable to lack of health insu rance in children before they receive health insurance; and 2) to examine t he effect of health insurance on these indicators within each age group of children (in years). Methods. We use cohort data on children before and after receiving health i nsurance. The study population consists of 750 children, 0 through 19 years of age, newly enrolling in two children's health programs. The families of the newly enrolled children were interviewed at the time of their enrollme nt (baseline), and again at 6 months and 1 year after enrollment. The depen dent variables measured included access to regular provider, utilization, u nmet need or delayed health care, and restrictions on activities attributab le to health insurance status. All these indicator variables were examined by age groups (0-5, 6-10, 11-14, and 15-19 years of age). chi(2) tests were performed to determine whether these dependent variables varied by age at baseline. Using logistic regression, odds ratios were calculated for baseli ne indicators by age group of child, adjusting for variables commonly found to be associated with health insurance status and utilization. Changes in indicator variables from before to after receiving health insurance within each age group were documented and tested using the McNemar test. A compari son group of families of children enrolling newly 12 months later were inte rviewed to identify any potential effects of trend. Results. All ages of children saw statistically significant improvements in access, reduced unmet/delayed care, dental utilization, and childhood acti vities. Before obtaining health insurance, older children, compared with yo unger children, were more likely to have had unmet/delayed care, to have no t received health care, to have low access, and to have had activities limi ted by their parents. This pattern held for all types of care except dental care. Age effects were strong and independent of covariates. After being c overed by health insurance, the majority of the delayed care, low utilizati on, low access, and limited activities in the older age groups (11-14 and 1 5-19 years) was eliminated. Thus, as levels of unmet need, delayed care, an d limitations in activities approached zero in all age groups by 1 year aft er receipt of health insurance, age variation in these variables was elimin ated. By contrast, age variation in utilization remained detectable yet gre atly reduced. Conclusion. Health insurance will reduce unmet need, delayed care, and rest ricted childhood activities in all age groups. Health care professionals an d policy makers also should be aware of the especially high health care del ay, unmet need, and restricted activities experienced by uninsured older ch ildren. The new state children's health insurance programs offer the potent ial to eliminate these problems. Realization of this potential requires tha t enrollment criteria, outreach strategies, and delivery systems be effecti vely fashioned so that all ages of children are enrolled in health insuranc e.