Abstract

Approximately 47 million Americans do not have health insurance and 11.4 percent of U.S. children did not have coverage in 2006. A representative, population-based dataset, the 2003 National Survey of Children’s Health (NSCH), was used to identify factors associated with US children (n=102,353)not having health insurance coverage through logistic regression with weighted samples. The dependent variable was lack of insurance or a gap in coverage during the previous 12 months. Using the Aday and Andersen Access to Medical Care Model, the risk of not having continuous coverage was examined in relation to predisposing, enabling, and need factors. Close to 15% of US children (0-17 years) experienced discontinuous health insurance coverage. Children at-risk are: children aged 5-12 years, children aged 13-17 years, Hispanic ethnicity, Black race, households where English was not the primary language, highest household education high school level, family poverty levels below 400%, poverty level unknown, parents do not have health insurance, lack of steady household employment, and children did not have a medical home. More enabling independent variables from the Aday and Andersen model were significant than the predisposing and need factors in the model. Policy should focus on the significant variables that can be changed to improve access to health care, i.e., poverty level, consistent household employment, parents’ health insurance status, and child’s access to a medical home. Health policy needs to address and incorporate interacting social determinants of health.