Maternal and Child Health Journal

, Volume 18, Issue 7, pp 1753–1764 | Cite as

The Impacts of Health Insurance Coverage on Access to Healthcare in Children Entering Kindergarten

  • Amanda Haboush-DeloyeEmail author
  • Spencer Hensley
  • Masaru Teramoto
  • Tara Phebus
  • Denise Tanata-Ashby


To examine access to healthcare and health outcomes for kindergartners as they relate to insurance status and type. For the 2008, 2009, and 2010 school years, surveys were distributed to parents with a child entering kindergarten in the state of Nevada. Surveys asked parents to provide information about their child concerning their insurance status, routine medical care, medical conditions, and health behaviors. Compared to their insured peers, uninsured kindergartners were less likely to have had a check-up in the previous 12 months (p < .001; OR 6.14; 95 % CI 5.77–6.53), have a primary physician (p < .001; OR 14.32; 95 % CI 13.49–15.20), or have seen a dentist (p < .001; OR 3.93; 95 % CI 3.70–4.16), and were more likely to have a reported unmet medical need (p < .001; OR 2.60; 95 % CI 2.19–3.07). Additionally, compared to children with private insurance, those children with public insurance were less likely to have had a check-up (p < .001; OR 1.73; 95 % CI 1.59–1.89), have a primary care provider (p < .001; OR 3.87; 95 % CI 3.55–4.21), and were more likely to have unmet medical needs (p < .001; OR 2.27; 95 % CI 1.83–2.81). For children in early development—a deeply critical period—insurance status and type are predictors of important access to healthcare variables.


Insurance coverage Medicaid Healthcare disparities Kindergarten Child 



Thank you to all the community partners that made this project possible such as all 17 county school districts, the Nevada State Health Division, Southern Nevada Health Department, and the staff at the UNLV Nevada Institute for Children’s Research and Policy. Funding for this project was provided by the Nevada State Health Division.


  1. 1.
    DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2013). Income, poverty, and health insurance coverage in the United States: 2012 (pp. P60–P245). Washington, DC: US Census Bureau, Current Population Reports.Google Scholar
  2. 2.
    Olson, L. M., Tang, S. F., & Newacheck, P. W. (2005). Children in the United States with discontinuous health insurance coverage. New England Journal of Medicine, 353(4), 382–391.CrossRefPubMedGoogle Scholar
  3. 3.
    Mancini, T., & Alker, J. (2013). Children’s health coverage on the eve of the affordable care act. Georgetown University Health Policy Institute Center for Children and Families. 2013 Nov 20. Accessed November 20, 2013.
  4. 4.
    The Annie E. Casey Foundation, Children without Health Insurance by Age Group. (2013). KIDS COUNT data center.,133,38,35,18/17,18,19/303,304. Accessed November 20, 2013.
  5. 5.
    Kataoka, S., & Zhang, L. (2011). Unmet need for mental health care among U.S., children: Variation by ethnicity and insurance status. American Journal of Psychiatric [serial online], 159(9), 1548. Available from: Academic Search Premier, Ipswich, MA. Accessed April 13, 2011.Google Scholar
  6. 6.
    Liu, J., et al. (2007). Disparities in dental insurance coverage and dental care among US children: The national survey of children’s health. Pediatrics, 119(S12), S12–S21.CrossRefPubMedGoogle Scholar
  7. 7.
    Iida, H., Lewis, C., Zhou, C., Novak, L., & Grembowski, D. (2013). Dental care needs, use and expenditures among U.S. children with and without special health care needs. Journal of American Dental Association, 141(1), 79–88. Accessed 6 November 2013.Google Scholar
  8. 8.
    Johnson, W. G., & Rimsza, M. E. (2004). The effects of access to pediatric care and insurance coverage on emergency department utilization. Pediatrics, 113(3), 483–487.CrossRefPubMedGoogle Scholar
  9. 9.
    Abdullah, F., Zhang, Y., Chang, D., et al. (2010). Analysis of 23 million US hospitalizations: Uninsured children have higher all-cause in-hospital mortality. Journal of Public Health, 32(2), 236–244.CrossRefPubMedGoogle Scholar
  10. 10.
    Valet, R. S., Kutny, D. F., Hickson, G. B., et al. (2004). Family reports of care denials for children enrolled in TennCare. Pediatrics, 114(1), e37–e42. Retrieved from EBSCOhost.Google Scholar
  11. 11.
    The Kaiser Commission. (2010). On medicaid and the uninsured: Medicaid: A primer. Washington, DC: The Henry J. Kaiser Family Foundation; Report #7334-04.Google Scholar
  12. 12.
    Centers for Medicare and Medicaid Services. (2011). Overview low cost health insurance for families and children. Accessed March 17, 2011.
  13. 13.
    Woodwell, D. A., & Cherry, D. K. (2004). National Ambulatory Medical Care Survey: 2002 summary. Advance Data, 26, 1–44.Google Scholar
  14. 14.
    dela Cruz, G. G., Rozier, R. G., & Slage, G. (2004). Dental screening and referral of young children by pediatric primary care providers. Pediatrics, 114, e642–e652.CrossRefPubMedGoogle Scholar
  15. 15.
    Kenney, G. M., & Coyer, C. (2012). National findings on access to health care and service use for children enrolled in medicaid or CHIP. MACPAC Contractor Report No. 1. March 2012.Google Scholar
  16. 16.
    Shonkoff, J. P., & Phillips, D. A. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.Google Scholar
  17. 17.
    Muennig, P., Robertson, D., Johnson, G., et al. (2011). The effect of an early education program on adult health: The Carolina abecedarian project randomized controlled trial. American Journal of Public Health [serial online], 101(3), 512–516.CrossRefGoogle Scholar
  18. 18.
    Shonkoff, J. P., Richter, L., van der Gaag, J., & Bhutta, Z. A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), e460–e472.CrossRefPubMedGoogle Scholar
  19. 19.
    Eriksson, J. G., Forsén, T., Tuomilehto, J., et al. (2003). Early adiposity rebound in childhood and risk of type 2 diabetes in adult life. Diabetologia, 46(2), 190–194.PubMedGoogle Scholar
  20. 20.
    Blackwell, D., Hayward, M., & Crimmins, E. (2001). Does childhood health affect chronic morbidity in later life? Social Science and Medicine, 52(8), 1269.CrossRefPubMedGoogle Scholar
  21. 21.
    Taras, H., & Potts-Datema, W. (2005). Chronic health conditions and student performance at school. Journal of School Health, 75(7), 255–266.CrossRefPubMedGoogle Scholar
  22. 22.
    Taras, H., & Potts-Datema, W. (2005). Obesity and student performance at school. Journal of School Health, 75(8), 291–295.CrossRefPubMedGoogle Scholar
  23. 23.
    Dóra Sigfúsdóttir, I., Kristjánsson, Á., & Allegrante, J. P. (2007). Health behaviour and academic achievement in Icelandic school children. Health Education Research, 22(1), 70–80. doi: 10.1093/her/cyl044.CrossRefGoogle Scholar
  24. 24.
    Bureau of Labor Statistics, US Department of Labor. Labor Force Statistics from Current Population Survey for United States. Available at
  25. 25.
    Bureau of Labor Statistics, US Department of Labor. Local Area Unemployment Statistics for Nevada. Available at
  26. 26.
    Holahan, J., & McGrath, M. (2013, March). Reversing the trend? Understanding the recent increase in health insurance coverage among the nonelderly population. Kaiser Commission on Medicaid and the Uninsured, Publication #8264-02. Washington, DC: Kaiser Family Foundation.
  27. 27.
    Bezruchka, S. (2009). The effect of economic recession on population health. CMAJ: Canadian Medical Association Journal [serial online], 181(5), 281–285. Available from: Academic Search Premier, Ipswich, MA. Accessed October 13, 2011.Google Scholar
  28. 28.
    Stern, J. (1983). The relationship between unemployment, morbidity, and mortality in Britain. Population Studies, 37, 61–74.CrossRefPubMedGoogle Scholar
  29. 29.
    Bolton, K., & Rodriguez, E. (2009). Smoking, drinking and body weight after re-employment: Does unemployment experience and compensation make a difference? BMC Public Health [serial online], 9, 1–12. Available from: Academic Search Premier, Ipswich, MA. Accessed November 13, 2013.Google Scholar
  30. 30.
    Paul, K, & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior [serial online], 74(3), 264–282. Available from: ERIC, Ipswich, MA. Accessed October 13, 2011.Google Scholar
  31. 31.
    Mossakowski, K. (2008). Is the duration of poverty and unemployment a risk factor for heavy drinking? Social Science & Medicine [serial online], 67(6), 947–955. Available from: SocINDEX with Full Text, Ipswich, MA. Accessed October 13, 2011.Google Scholar
  32. 32.
    Madge, N. (2006). Unemployment and its effects on children. Journal of Child Psychology and Psychiatry, 24(2), 311–319.CrossRefGoogle Scholar
  33. 33.
    Felland, L. E., Cunningham, P. J., Cohen, G. R., et al. (2010). The economic recession: Early impacts on health care safety net providers. Research Brief, 15, 1–8.PubMedGoogle Scholar
  34. 34.
    Martin A, Lassman D, Whittle L, et al. (2011). Recession contributes to slowest annual rate of increase in health spending in five decades. Health Affairs [serial online], 30(1):11–22. Available from: CINAHL, Ipswich, MA. Accessed October 13, 2011.Google Scholar
  35. 35.
    U.S. Department of Health and Human Services. (2009). Health Resources and services administration, maternal and child health bureau. The National Survey of Children’s Health 2007. Rockville, Maryland: U.S. Department of Health and Human Services.
  36. 36.
    Lewis, C. W., Grossman, D. C., Domoto, P. K., et al. (2000). The role of the pediatrician in the oral health of children: A national survey. Pediatrics, 106(6), E84.CrossRefPubMedGoogle Scholar
  37. 37.
    Gift, H. C., Reisine, S. T., & Larach, D. C. (1992). The social impact of dental problems and visits. American Journal of Public Health, 82, 1663–1668.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Alm, A., Wendt, L., Koch, G., et al. (2008). Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age. Caries Research, 42(1), 28–36.CrossRefPubMedGoogle Scholar
  39. 39.
    US Department of Health and Human Services. (2000). Oral health in America: A report of the surgeon general. Rockville, MD: US Dept of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.Google Scholar
  40. 40.
    Blewett, L., Davern, M., & Rodin, H. (2004). Covering kids: Variation in health insurance coverage trends by state, 1996–2002: Despite nationwide improvements, variation persists in levels of children’s coverage among states. Health Affairs, 23(6):170–180. Available from: CINAHL, Ipswich, MA. Accessed May 9, 2011.Google Scholar
  41. 41.
    Center for Labor Market Studies. (2009). Northeastern University and the Chicago Alternative Schools Network. Boston, MA and Chicago, Ill: Left Behind in America: The Nation’s Dropout Crisis.Google Scholar
  42. 42. (2011). NevadaKaiser State Health Facts. Available at: Accessed March 17, 2011.
  43. 43.
    Kaiser Family Foundation. (2009, January 1). Enrolling uninsured low-income children in Medicaid and SCHIP. Kaiser Commission on Medicaid and the Uninsured, Medicaid Facts #2177-06. Washington, DC: Kaiser Family Foundation. Accessed November 13, 2013.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Amanda Haboush-Deloye
    • 1
    Email author
  • Spencer Hensley
    • 2
  • Masaru Teramoto
    • 3
  • Tara Phebus
    • 1
  • Denise Tanata-Ashby
    • 4
  1. 1.Nevada Institute for Children’s Research and PolicyUniversity of Nevada, Las VegasLas VegasUSA
  2. 2.Division of Public Behavioral Health and Justice PolicyUniversity of WashingtonSeattleUSA
  3. 3.Department of Health Sciences, College of Nursing and Health ProfessionsDrexel UniversityPhiladelphiaUSA
  4. 4.Children’s Advocacy AllianceLas VegasUSA

Personalised recommendations