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Health Insurance Status of U.S. Children

An estimated 19% of U.S. children are underinsured.

Many children in the U.S. are underinsured or lack any health insurance. Investigators estimated the prevalence of underinsurance among U.S. children by analyzing parent-reported data from a nationally representative sample of 91,642 children (age, <18 years) in a 2007 survey. Children were classified as underinsured if the parent of a continuously insured child reported that necessary services and providers frequently were not covered or that out-of-pocket expenses were unreasonable.

An estimated 11 million children (15% of all children) were without health insurance for all or part of the year, 14 million (19%) were continuously insured but were underinsured, and 48 million (66%) were classified as continuously and adequately insured. Being underinsured was significantly associated with being older, having special healthcare needs, and being in fair or poor health. Compared with children with adequate insurance, underinsured children were significantly more likely to have no medical home (54.5% vs. 34.6%), to have delayed or forgone care in the past year (10.9% vs. 3.4%), and to have difficulty obtaining specialist care (25.5% vs. 14.6%).

Comment: This study has two important limitations — insurance adequacy was determined on the basis of parental report, and consequences of limited health insurance were not assessed. Although few studies have shown that underinsurance substantially affects child well-being, this study's findings support the provision of universal adequate coverage for all children.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine September 8, 2010

Citation(s):

Kogan MD et al. Underinsurance among children in the United States. N Engl J Med 2010 Aug 26; 363:841.

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