By Martha Heberlein

So often, the focus has been on getting uninsured children covered. While this is certainly a very laudable goal, far less attention has been paid to the adequacy of this coverage. Does it offer benefits or cover services that meet the child’s needs?  Does it allow the child to see the health care providers he or she needs? Are the out-of-pocket costs for this coverage affordable to the family?

A recent study in the New England Journal of Medicine looked at the adequacy of health coverage for children and discovered some pretty depressing results. Relying on data from the National Survey of Children’s Health, the authors estimate that 19.3% (or 14.1 million) of all U.S. children were underinsured in 2007; a figure that far exceeds the number of children without coverage. The results varied by group – with older children, Hispanic and African American children, as well as those with special health care needs more likely to be underinsured.

Interestingly, among those with continuous coverage, children with private coverage were far more likely to be underinsured than their publicly-covered counterparts. This is likely due to the fact that the most common reason for underinsurance was that the out-of-pocket costs were “unreasonable” to the family and Medicaid and CHIP provide better protection against these expenses.

Similar to their uninsured peers, children with inadequate insurance were found more likely to be without a medical home, to have delayed or gone without needed care, and to have difficulty accessing specialist care.

As we move forward with implementing health reform, this study should drive home an important point – coverage isn’t everything. The adequacy of that coverage may be just as vital to children’s health and access to needed care.