Continuity of Insurance Coverage and Ambulatory Care–Sensitive Hospitalizations/ED Visits

Abstract

To assess the effects of continuity of insurance coverage on treatment of ambulatory-care sensitive conditions (ACSC). 42,382 children enrolled in ALL Kids (Alabama Children's Health Insurance Program) for 3 or more years. We model annual hospitalizations and ED visits for six ACSCs identified by the AHRQ - bacterial pneumonia, dehydration, perforated appendix, urinary tract infection, gastroenteritis, and severe ear, nose and throat infection. In unadjusted models, we find lower risk of ACSC hospitalizations and ED visits in the second and third years of continuous enrollment. Risk of hospitalization in year 3 was significantly lower for pneumonia (OR 0.608, 95% CI: 0.421-0.878) and gastroenteritis (OR 0.549, 95% CI: 0.404-0.746). These beneficial effects of duration of coverage disappear after controlling for age, year and other enrollee characteristics. Hospitalizations and ED visits for ACSCs are rare and do not decrease with additional years of coverage.