Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021 Article Swipe
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1001/jamahealthforum.2023.4179
Importance Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. Objective To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. Design, Settings, and Participants This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children’s Health of children from age 0 to 17 years living in noninstitutional settings. Exposure Parent- or caregiver-reported current child health insurance type defined as public or commercial. Main Outcomes and Measures Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child’s needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child’s health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. Results Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, −20.8 pp; 95% CI, −21.6 to −20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. Conclusions and Relevance The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children’s health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children.
Related Topics
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamahealthforum.2023.4179
- https://jamanetwork.com/journals/jama-health-forum/articlepdf/2812105/daw_2023_oi_230081_1700512981.71135.pdf
- OA Status
- gold
- Cited By
- 15
- References
- 14
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4388895854
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4388895854Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamahealthforum.2023.4179Digital Object Identifier
- Title
-
Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021Work title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-11-22Full publication date if available
- Authors
-
Jamie R. Daw, S Yekta, Faelan E. Jacobson‐Davies, Stephen W. Patrick, Lindsay K. AdmonList of authors in order
- Landing page
-
https://doi.org/10.1001/jamahealthforum.2023.4179Publisher landing page
- PDF URL
-
https://jamanetwork.com/journals/jama-health-forum/articlepdf/2812105/daw_2023_oi_230081_1700512981.71135.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://jamanetwork.com/journals/jama-health-forum/articlepdf/2812105/daw_2023_oi_230081_1700512981.71135.pdfDirect OA link when available
- Concepts
-
Medicine, Payment, Public health, Logistic regression, Public health insurance, Actuarial science, Health care, Consistency (knowledge bases), Environmental health, Family medicine, Health insurance, Business, Nursing, Finance, Economic growth, Geometry, Economics, Mathematics, Internal medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
15Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 13, 2024: 2Per-year citation counts (last 5 years)
- References (count)
-
14Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.children | 14, 76, 220, 257, 290, 343, 353 |
| abstract_inverted_index.coverage | 45, 136, 296, 315, 419 |
| abstract_inverted_index.female). | 216 |
| abstract_inverted_index.findings | 378 |
| abstract_inverted_index.improved | 411 |
| abstract_inverted_index.indicate | 383 |
| abstract_inverted_index.logistic | 160 |
| abstract_inverted_index.outcomes | 166 |
| abstract_inverted_index.payments | 154 |
| abstract_inverted_index.publicly | 12, 47, 195, 218, 288, 341, 392, 435 |
| abstract_inverted_index.Improving | 416 |
| abstract_inverted_index.Objective | 27 |
| abstract_inverted_index.Relevance | 376 |
| abstract_inverted_index.Settings, | 53 |
| abstract_inverted_index.challenge | 404 |
| abstract_inverted_index.children, | 192, 287, 394 |
| abstract_inverted_index.children. | 51, 408, 437 |
| abstract_inverted_index.child’s | 133, 156 |
| abstract_inverted_index.criteria: | 126 |
| abstract_inverted_index.decreased | 337, 347 |
| abstract_inverted_index.different | 18 |
| abstract_inverted_index.emergency | 8 |
| abstract_inverted_index.household | 243, 271 |
| abstract_inverted_index.insurance | 94, 111, 168, 180, 336, 346, 369, 372, 385, 396 |
| abstract_inverted_index.obtaining | 21 |
| abstract_inverted_index.settings. | 86 |
| abstract_inverted_index.solutions | 426 |
| abstract_inverted_index.−20.0). | 326 |
| abstract_inverted_index.(2020-2021 | 172 |
| abstract_inverted_index.Importance | 0 |
| abstract_inverted_index.associated | 40, 364 |
| abstract_inverted_index.challenges | 19, 410 |
| abstract_inverted_index.consistent | 22 |
| abstract_inverted_index.inadequacy | 397 |
| abstract_inverted_index.inadequate | 44, 118, 314, 345, 366 |
| abstract_inverted_index.insurance, | 106, 119 |
| abstract_inverted_index.insurance. | 26 |
| abstract_inverted_index.nationally | 62, 185 |
| abstract_inverted_index.particular | 389 |
| abstract_inverted_index.percentage | 302 |
| abstract_inverted_index.reasonable | 151 |
| abstract_inverted_index.regression | 161 |
| abstract_inverted_index.sufficient | 130 |
| abstract_inverted_index.2016-2019), | 174 |
| abstract_inverted_index.Conclusions | 374 |
| abstract_inverted_index.PHE-related | 33 |
| abstract_inverted_index.commercial. | 100 |
| abstract_inverted_index.difference, | 300, 319 |
| abstract_inverted_index.(2020-2021). | 358 |
| abstract_inverted_index.Children’s | 73 |
| abstract_inverted_index.Inconsistent | 105 |
| abstract_inverted_index.Participants | 55 |
| abstract_inverted_index.children’s | 417 |
| abstract_inverted_index.commercially | 10, 49, 208, 255, 285, 351, 406, 433 |
| abstract_inverted_index.inconsistent | 42, 295, 335, 368 |
| abstract_inverted_index.non-Hispanic | 223, 259 |
| abstract_inverted_index.out-of-pocket | 153, 400 |
| abstract_inverted_index.particularly, | 399 |
| abstract_inverted_index.practitioners; | 145 |
| abstract_inverted_index.representative | 63, 186 |
| abstract_inverted_index.usually/always | 129, 137, 150 |
| abstract_inverted_index.Survey-weighted | 159 |
| abstract_inverted_index.characteristics | 39, 178, 363 |
| abstract_inverted_index.cross-sectional | 59, 381 |
| abstract_inverted_index.noninstitutional | 85 |
| abstract_inverted_index.caregiver-reported | 90 |
| cited_by_percentile_year.max | 100 |
| cited_by_percentile_year.min | 94 |
| corresponding_author_ids | https://openalex.org/A5025481094 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 5 |
| corresponding_institution_ids | https://openalex.org/I78577930 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/1 |
| sustainable_development_goals[0].score | 0.7599999904632568 |
| sustainable_development_goals[0].display_name | No poverty |
| citation_normalized_percentile.value | 0.96932764 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |