Switching Health Insurance and Its Effects on Access to Physician Services

• DOI: 10.1097/mlr.0b013e318187d8db
• Publication Date: 2008-09-22T07:08:30Z
• Authors: Shana Alex Lavarreda; Melissa Gatchell; Ninez Ponce; E Richard Brown; Y Jenny Chia
• Keywords: Adult; Male; Medically Uninsured; Insurance, Health; Health Status; Infant, Newborn; Infant; Continuity of Patient Care; Middle Aged; Health Surveys; California; Health Services Accessibility; Insurance Coverage; 3. Good health; Interviews as Topic; 03 medical and health sciences; Logistic Models; 0302 clinical medicine; Child, Preschool; Humans; Female; Health Services Research; Child

This study examines the factors associated with discontinuous health insurance coverage without periods of uninsurance during the past year (ie, switching coverage), and whether it has a detrimental effect on basic access to care.We analyze the 2003 California Health Interview Survey samples of adults, ages 19-64 (n = 32,850) and children, ages 0-18 (n = 13,062), using weighted bivariate and multivariate analyses. We stratified the population first by age (modeling adults separately from children) and then by health status (modeling the full population and the population reporting fair or poor health separately).Income, race/ethnicity, age, gender, and rural status were significant factors associated with switching coverage. Adults who switched insurance had significantly reduced odds of having a usual source of care [odds ratio (OR) = 0.63, P < 0.001)] compared with those with continuous coverage. In addition, adults and children who switched coverage were significantly more likely to report delaying care because of cost or insurance issues (adults: OR = 1.65, P < 0.001; children: OR = 2.00, P < 0.001). Children in fair or poor health who switched insurance coverage had much higher odds of reporting a delay in care (OR = 5.48, P < 0.001).Children and adults had disruptions in their basic access to health care when they experienced discontinuous insurance. These findings highlight the advantages of retention of enrollees as one means of promoting access to health care, in the short term, and the benefit of a continuous national health insurance program in the long term.