WEDNESDAY, Aug. 25 (HealthDay News) -- Even prior to the onset
of the economic recession in 2008, nearly one in four American
parents with health insurance reported that their coverage was so
inadequate they were unable to access the medical care their
Parents of kids with health problems or special needs were more
likely than others to say their insurance coverage did not meet
their needs, the analysis of 2007 survey data showed.
And the problem of "underinsurance" seems to be worse for
children covered by private insurance than those with
government-funded coverage, the study found.
About a quarter (24.2 percent) of children with private health
insurance had problems getting the care they needed, compared to
14.7 percent of children with public health insurance, such as
Medicaid or the State Children's Health Insurance Program
"Almost one-fourth of kids with continuous insurance were inadequately covered or underinsured, which is coverage that doesn't provide adequate benefits or provides poor coverage of costs from the parents' perspective," said lead study author Michael Kogan, director of the Office of Epidemiology, Policy and Evaluation at the Health Resources and Services Administration.
The study is published in the Aug. 26 issue of the
New England Journal of Medicine.
Researchers analyzed data on nearly 92,000 children who parents
took part in the 2007 National Survey of Children's Health.
An estimated 11 million U.S. children were uninsured for some or
all of 2007, including 3.4 million kids who had no coverage and 7.6
million who were covered part of the year, while 14.1 million had
continuous coverage but were "underinsured."
Even if they had continuous insurance coverage, adolescents,
Hispanics, children in fair or poor health and children with
special needs were more likely to have trouble accessing the care
they needed, according to the study.
Parents were asked whether their child's health insurance
offered benefits and covered services the child needed; whether the
insurance allowed the child to see needed health care providers;
and if the costs for deductibles, co-pays and other services not
covered were reasonable.
Parents of kids with private insurance were three times more
likely to report that the out-of-pocket costs for services not
covered were "unreasonable," compared to people with public
For many parents, that resulted in delaying or forgoing care for
their children, according to the study. Children whose parents
reported they were "underinsured" were more than 3 times more
likely than children with adequate coverage to delay or go without
Uninsured kids were more than four times more likely to have
delayed or skipped medical care than kids with adequate insurance,
although the difference was not statistically significant as
compared to kids who were underinsured, Kogan said.
"We found that kids who are underinsured are having some of the same problems with health care access and quality as kids who are uninsured," Kogan said.
While asking parents about their perceived "reasonableness" of
costs is not an objective measure of affordability, the study does
highlight serious problems of accessing health care for America's
children, said Dr. James Perrin, a professor of pediatrics at
Harvard Medical School.
"What these researchers have demonstrated is that underinsurance is bad, almost as bad as being uninsured," Perrin said. "What we do know is children are not getting a lot of the services they should be getting."
Recent health reform legislation may help, but not solve, the
problem, Perrin said. Although more children will have some sort of
insurance, issues with the affordability of co-pays and
deductibles, as well as limitations on benefits, will likely
continue, he said.
The problem takes on even greater urgency considering that
studies show more children have health issues such as asthma,
obesity, autism, mental health conditions and diabetes, he
"We know from other articles there is a tremendous increase in rates of chronic illness and disability among American children and young adults," Perrin said.
There's more on the State Children's Health Insurance Program
and Medicaid at