Evidence is clear that uninsured children receive fewer health care services than children who have insurance coverage. Compared with children who have insurance coverage, uninsured children have fewer visits to physicians, are less likely to be seen by physicians when they are sick or injured, and are less likely to receive adequate preventive services, including immunizations.

Untreated illnesses and injuries can have long-term-even lifelong-consequences. For example, untreated ear infections can lead to hearing loss or deafness. Children who are unable to hear well can have trouble performing well in school and trouble interacting normally with their families and friends. Language or other developmental delays due to untreated neurological problems also can frustrate normal development and social interactions.

Although children who are uninsured have less access to care, it is important to recognize that the presence of insurance alone will not eliminate all of the barriers to accessing appropriate health care services. Children are dependent on their parents to identify problems and seek treatment, and even insured and responsible parents may delay seeking care because of the cost of the out-of-pocket expenses or because it is difficult or inconvenient to schedule appointments. Delays in ambulatory care because of cost may result in diagnosis or treatment later in the course of illness or disease, when treatment may be more complex and more expensive.

Some aspects of the health care system also can create barriers to access, particularly the shortages of providers to serve low-income groups, lack of cultural sensitivity, and inconvenient scheduling. With an increasing emphasis on the quality of care, it is likely that some of these aspects will begin to change over time.

In the meantime, health insurance expansions for children should emphasize benefits that include preventive services and age-appropriate interventions. With health insurance, children are more likely to experience healthy physical and emotional growth, development, and overall health and well-being. Without insurance, their health care needs are far more likely to go unmet.

If we get all kids covered, that is not going to solve all of their health problems, but it is going to make solving them a lot easier.

John McDonough

Massachusetts Legislature, Boston, MA

Public Workshop, June 2, 1997

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