Continuity of insurance coverage and ambulatory care-sensitive hospitalizations/ED visits: Evidence from the children's health insurance program

David J. Becker, Justin L. Blackburn, Meredith L. Kilgore, Michael A. Morrisey, Bisakha Sen, Cathy Caldwell, Nir Menachemi

Research output: Contribution to journalArticle

8 Scopus citations


Objective: To assess the effects of continuity of insurance coverage on treatment of ambulatory-care sensitive conditions (ACSC). Study Population: 42,382 children enrolled in ALL Kids (Alabama Children's Health Insurance Program) for 3 or more years. Methods: 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. Results: 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. Conclusions: Hospitalizations and ED visits for ACSCs are rare and do not decrease with additional years of coverage.

Original languageEnglish (US)
Pages (from-to)963-973
Number of pages11
JournalClinical Pediatrics
Issue number10
StatePublished - Oct 1 2011
Externally publishedYes



  • Children's Health Insurance Program
  • ambulatory care sensitive conditions
  • continuity of coverage
  • quality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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