Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

How Insurance Instability Impacts Children

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Project Number: R40 MC06633-02
Grantee: Children's Hospital Medical Center
Project Date: 01/01/2006

Final Report

How Insurance Instability Impacts Children Final Report (PDF) Exit Disclaimer

Principal Investigator

Gerry Fairbrother, Ph.D.
3333 Burnet Avenue, MLC 5041
Cincinnati, OH  45229-3039
Phone: 513-636-0189


  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)


The purpose of this study is to examine patterns and correlates of unstable insurance patterns for children, focusing on instability for vulnerable populations. It will do so by describing health insurance coverage patterns for all children and specific subgroups of children, exploring factors that may contribute to unstable insurance patterns, and assessing prevalence of trigger events, such as divorce, marriage or job changes that may be antecedents of coverage loss. Health insurance coverage is an important component for optimal health care for children. Recently published studies have described unstable patterns and correlates for the under 65 population, but there are no similar thorough studies focusing on children. Yet, patterns may be different for children due to the greater availability of public coverage. The problem of gaps in coverage is of particular concern for our nation's most vulnerable children - those from low-income, immigrant, and racial/ethnic minority groups. Further, gaps in coverage are likely to disproportionately affect those children enrolled in public insurance programs because of the requirements for periodic re-assessment of eligibility. Given the lack of knowledge about insurance stability in children, this study aims to: 1) describe and define unstable insurance patterns for children, 2) describe antecedents of coverage loss for children as a whole and for subgroups of children, and 3) contrast the frequency and duration of gaps in coverage by insurance types (public vs. private) and for subgroups of children. The results of this study will provide important information that is directly applicable to designing improvements in the health care infrastructure and systems of care to reduce insurance instability for children. In addition, this study can help elucidate the association of unstable insurance coverage with public vs. private coverage and for racial and ethnic subgroups. This study will be based on data collected in the Medical Expenditure Panel Survey for 2000 to 2002, which is a nationally representative, longitudinal survey that includes health information on children. In order to address our hypotheses, we will use univariate statistics and bivariate comparisons, and develop multivariate models to examine correlates of unstable insurance coverage.


Listed is descending order by year published.

Fairbrother GL, Carle AC, Cassedy A, Newacheck PW. The impact of parental job loss on children's health insurance coverage. Health Aff (Millwood). 2010 Jul;29(7):1343-9.

Cassedy A, Fairbrother G, Newacheck PW. The impact of insurance instability on children's access, utilization, and satisfaction with health care. Ambul Pediatr. 2008 Sep-Oct;8(5):321-8. Epub 2008 Jun 16.


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