Gaps in insurance coverage increase disparities in pediatric vision care access

In the United States, gaps in insurance coverage or lack of insurance may lead to greater unmet needs for vision care in children and lower rates of vision screening.

Study design

Deidentified data regarding caregiver-reported unmet needs for vision care in the past 12 months were collected from the 2016–2019 National Survey of Children’s Health and were analyzed for 108,876 children aged 3–17 years. Additional data examined included whether the child had their vision tested within the previous 12 months and health insurance coverage over that time period, adjusting for age, sex, race/ethnicity, and socioeconomic variables.

Outcomes

Four percent of children had a recent gap in health insurance coverage and 5% of children lacked insurance in the 12 months prior to the survey. While less than 1% of the population had caregiver-reported unmet vision care needs, this was 19 times higher in children with gaps in insurance coverage and 9 times higher in children with no insurance in the year prior to the survey. As well, children with gaps in coverage had 40% lower odds of completing vision screening than those with year-round private coverage.

Limitations

This study is based on caregiver-reported data regarding insurance coverage, which may have led to either underreporting or overreporting.

Clinical significance

Children with gaps in coverage may have had a higher rate of caregiver-reported unmet vision care need than those with year-round lack of coverage, as prior care may have identified a vision impairment and increased caregiver awareness. Policy interventions, including expansion of public health insurance, increased accessibility of enrollment, and greater public vision screening initiatives should be considered in order to increase access to vision care in underserved populations.