Continuity of Insurance Coverage and Ambulatory Care-Sensitive Hospitalizations/ED Visits: Evidence From the Children's Health Insurance Program

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.