Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Health Services

Health Services And Children with Special Health Care Needs: The Role Of Family Poverty In Information and Access

This project examines the association between family poverty, health insurance coverage, perceived necessity, and use of health care services among children with special health care needs. First, the role of health services for these children is analyzed, contrasting needs specified by parents in poverty with needs specified by higher-income parents, holding severity of functional limitations constant. Second, variations in utilization of health services by poverty status are analyzed, paying particular attention to the role of health insurance coverage in providing financial support for these services.

The project uses data drawn from the National Survey of Children with Special Health Care Needs (CSHCN), collected in 2001 by the Centers for Disease Control and Prevention. In the first phase, descriptive analysis is used to examine the relationship between family characteristics, expressed needs (proxy for access to information), access to specialized health services, and measures of functional limitations. Variables documenting reasons for delay in receiving services or for not receiving the appropriate level of services are also examined descriptively. In the second phase of this analysis, formal econometric models are used to examine the relationship between family poverty, child functional limitations, type of health insurance coverage, and the need for and access to specialized health services. Since by definition all children with special health care needs use health services, the multivariate analysis is addressed through specification of a multinomial logit model with dependent variables indicating that the service was not considered necessary, the service was considered necessary but not received, or the service was considered necessary and received. Separate estimations are completed for each of 14 specific types of services.

The CSHCN survey contains 38,866 respondents and is designed to provide state and national estimates on the prevalence and health services use of special-needs children.

Regardless of the severity of children’s functional limitations, low-income families (below 200% of poverty) and families in which the mother has a high school education or less are significantly less likely to report that their child needs routine preventive, specialist, or dental care, or prescription medications. These families are significantly more likely to report that their child needs mental health care. Among families with children with the most severe functional limitations, those with less educated mothers are significantly less likely to report family needs for professional care coordination or respite care.

Nearly one in five families in the U.S. have children with special health care needs. Though these are as likely as other children to have health insurance coverage, a significant barrier appears to be lack of access to information about the appropriate health care services needed.

Results of this study point to the importance of targeted outreach to families in poverty who have children with special health care needs. This study provides a better understanding of the barriers experienced by low-income parents in providing care for their special-needs children and much needed information concerning private market and public policy success and failure in the delivery of specialized health services.

See more of Health Services
See more of Oral and Poster

See more of Celebrating a Decade of SSWR (January 13 - 16, 2005)