Early-Childhood Insurance Gaps and Preventive Care Outcomes Among Young Children in a Low-Barrier Pediatric Mobile Clinic in Washington, D.C.
Jeff Huang, Shelby Wyand, Joanne S. Odom, LICSW, Janine A. RethyIntroduction
The first two years of life include up to ten recommended primary care visits critical for establishing children’s health trajectories. Insurance gaps during this period can limit access to preventive care and may signal broader barriers to engagement. A pediatric mobile van clinic in Washington, D.C. delivers comprehensive, low-barrier care regardless of insurance status in a population with prevalent health-related social needs.
Objectives
To quantify the prevalence of early-childhood insurance gaps (EIG), defined as any coverage lapse in the first two years of life, among children receiving care at the clinic, and to examine whether EIG were associated with decreased well-child visit (WCV) attendance and vaccination coverage.
Design
Retrospective cohort study of children aged 0-2 years receiving care at a pediatric mobile-van clinic between March 2019 and December 2024.
Methods
EIG were identified from billing records. Outcomes included WCV attendance and vaccination coverage, compared between children with EIG and continuously insured children.
Results
Among 85 children, 46% experienced EIG, including 38% with gaps before age two months. Among children with EIG, a median of 36% of attended well-child visits occurred without insurance coverage. Overall, children attended 79% of expected WCV and received 84% of expected vaccine doses. No significant differences in WCV attendance or overall vaccination coverage were observed by EIG status.
Conclusions
This population demonstrated a high prevalence of EIG during a critical developmental period. EIG were not associated with reduced WCV attendance or vaccination completion, which may reflect the clinic’s low-barrier, comprehensive care model. These findings highlight limitations of existing cross-sectional insurance metrics in capturing early childhood coverage gaps and suggest tailored care models warrant further study as a strategy for supporting preventive care equity in high-risk populations.