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Kogan, Michael D.; Alexander, Greg R.; Teitelbaum, Martha A.; Jack, Brian W.; Kotelchuck, Milton; & Pappas, Gregory (1995). The Effect of Gaps in Health Insurance on Continuity of a Regular Source of Care among Preschool-Aged Children in the United States. JAMA: Journal of the American Medical Association, 274(18), 1429-1435.


OBJECTIVE: To estimate the prevalence and length of gaps in health insurance coverage and their effect on having a regular source of care in a national sample of preschool-aged children.
DESIGN: Follow-up survey 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 longitudinal Follow-up to the National Maternal and infant Health Survey.
MAIN OUTCOME MEASURES: Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the children were taken for medical care as a measure of continuity of a regular source of care.
RESULTS: About one quarter of Us children were without 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 more than 6 months. Less than half of US children had only one site of care during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one care site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). This risk further increased when an emergency treatment was discounted as a multiple site of care.
CONCLUSIONS: Having a gap in health insurance coverage is an important determinant for not having a regular source of care for preschool-aged children. This finding is of concern, given the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of development.


Reference Type

Journal Article

Year Published


Journal Title

JAMA: Journal of the American Medical Association


Kogan, Michael D.
Alexander, Greg R.
Teitelbaum, Martha A.
Jack, Brian W.
Kotelchuck, Milton
Pappas, Gregory