Insurance Gaps May Increase Emergency Department Visits in Children With Asthma

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Gaps in insurance coverage increased the odds of asthma-related emergency department intervention or hospitalization and exacerbations.

Insurance coverage gaps for children with asthma may result in increased emergency department use, possibly related to inferior access to health care, according to an analysis published in the Journal of Asthma.

Researchers culled data from the National Survey of Children’s Health, conducted by the Data Resource Center for Child and Adolescent Health, to study the effect of insurance coverage on children with asthma. A total of 3739 children were included in the analysis. The patterns of insurance coverage analyzed included constant private insurance, ongoing public insurance, gaps in insurance coverage within the last year, and continuous lack of insurance coverage. Following this, the researchers compared their findings with data from the National Health Interview Survey conducted by the US Centers for Disease Control and Prevention. This comparison included 855 children with asthma.

The National Survey of Children’s Health data showed that 116 (4%) children with asthma had health care needs unaddressed because of cost. Gaps in coverage (odds ratio [OR], 13.2; 95% CI, 5.1-34.3; P <.001) and year-round lack of insurance coverage (OR, 22.1; 95% CI, 4.9-99.0; P <.001) were strongly linked to unaddressed health care needs in multivariable analysis. In the National Health Interview Survey, gaps in coverage increased the odds of asthma-related emergency department intervention or hospitalization (OR, 4.3; 95% CI, 1.4-12.6; P =.009) and asthma exacerbations (OR, 3.7; 95% CI, 1.4-10.4; P =.011) compared with children who had no gaps in private insurance coverage.

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The results suggest that children with asthma who have gaps in their insurance coverage use emergency department services more often than those who do not experience coverage gaps. The researchers concluded that “protecting insurance coverage may reduce ED [emergency department] utilization and exacerbations in this population.”


Gushue C, Miller R, Sheikh S, et al. Gaps in health insurance coverage and emergency department use among children with asthma [published online October 26, 2018]. J Asthma. doi:10.1080/02770903.2018.1523929