Access to Health Care for Children With Special Health Care Needs

“…1,2 Population-based studies in the past 15 years have identified dental care as a leading unmet health care need among children in general 3,4 and children with disabilities. 2 However, little is known about the characteristics of children with special health care needs (CSHCN) who have unmet dental care needs. In fact, very few data exist to describe the oral health status or dental care needs of CSHCN.…”

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confidence: 99%

Unmet Dental Care Needs Among Children With Special Health Care Needs: Implications for the Medical Home

2005

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ABSTRACT. Background. Little is known about the characteristics of children with special health care needs (CSHCN) who have unmet dental care needs.Objective. We sought to describe the magnitude of unmet needs for dental care among CSHCN and to characterize those with unmet dental care needs.Design, Setting, and Subjects. We used data from the National Survey of Children with Special Health Care Needs, which used a telephone survey to identify 750 CSHCN from each of the 50 states and the District of Columbia. Families of 38 866 CSHCN were interviewed, and the data were weighted to represent 9.32 million CSHCN nationally.Outcome. Our primary outcome of interest was unmet dental care need, defined as whether CSHCN were said to have needed dental care but were unable to obtain it. We also considered reasons why a child had an unmet dental care need and compared other categories of health care service needs and unmet needs with dental care. Bivariate and multivariate analyses were conducted to determine factors associated with unmet dental care needs.Results. Overall, 78% of CSHCN were reported as needing dental care in the past 12 months, which was second only to prescription medications in the frequency of need. Of those who reported a dental care need, an estimated 755 581 or 10.4% of CSHCN did not receive all of the dental care they needed. Relative to all other health care service categories, unmet dental care needs affected the most children. Poorer children, uninsured children, children with lapses in insurance, and children with greater limitations attributable to disability had significantly greater odds of unmet dental care needs in multivariate analyses. Children with a personal doctor or nurse were significantly less likely to have unmet dental care needs.Conclusions. Dental care is the most prevalent unmet health care need for CSHCN, affecting substantially more children than any other health care need category. Moreover, the perceived need for dental care for CSHCN exceeds the need for either preventive or specialty medical care. Given these findings, dental care should be an integral and explicitly stated part of the comprehensive coordinated services that the medical home aims to provide for CSHCN. Greater efforts to improve access to dental care for poor and more disabled CSHCN are needed. Pediatrics 2005;116:e426-e431. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2005-0390; dental, access, children with special health care needs.

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“…They need a broad array of services 3 and have out-of-pocket expenses that are significantly greater than for other children. [4][5][6] Public insurance, such as SCHIP, may be particularly desirable for children with chronic conditions, to the extent that it covers a broader spectrum of services than private insurance plans 7 and shifts the financial burden away from the family. Although many of the separate SCHIP plans offer a more limited scope of covered services than Medicaid, 8 most SCHIP plans have a broader scope of coverage and less cost sharing than private insurance plans.…”

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confidence: 99%

Effects of the State Children's Health Insurance Program Expansions on Children With Chronic Health Conditions

2005

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ABSTRACT. Objective. To estimate the effects of the State Children's Health Insurance Program (SCHIP) expansions on insurance coverage, use of health care services, and access to care for children with chronic health conditions.Methods. The primary source of data was the National Health Interview Survey. Children with chronic health conditions were identified primarily through reported diagnoses of common chronic conditions (eg, asthma, attention-deficit disorder, mental retardation, Down syndrome, cerebral palsy, muscular dystrophy, sickle cell disease, diabetes, arthritis, heart disease) and on the presence of activity limitations caused by a health problem lasting at least 12 months. We examined changes in a broad array of outcomes for children with chronic health conditions who gained eligibility under SCHIP or who were already eligible for coverage under Medicaid, comparing the periods before and after implementation of the program. Changes for these treatment groups were compared with children with slightly higher incomes, who should not have been affected by the eligibility expansions. Comparisons were made with adjustment for child, family, and other characteristics that might have independent effects on the outcomes of interest. Outcomes included health insurance coverage, use of general and specialty services, access to care, and out-ofpocket spending on health care. Selected analyses were conducted for children not identified as having chronic health conditions.Results. The SCHIP expansions resulted in a 9.8 percentage point increase in the proportion of children with chronic conditions reporting public insurance and a 6.4 percentage point decline in the proportion uninsured. Unmet need for health care decreased by 8 percentage points, with most of the decline found for dental care. Increases in specialist, eye care, and dental visits and decreases in out-of-pocket spending and emergency-department and mental health visits were observed but did not meet standards of statistical significance. Estimated reductions in unmet need were greater for children with chronic conditions than for other children.Conclusions. Recent expansions in public insurance eligibility under SCHIP have improved coverage for children with chronic conditions, with selected improvements in access to care. However, some eligible children with chronic conditions remain uninsured, and the impact on access to care and service use were limited. Additional progress may require targeted outreach to children with chronic conditions and improvements in Medicaid and SCHIP service-delivery systems. Given the current fiscal environment and the fact that children with chronic conditions have not generally been protected from cutbacks, the recent progress documented in this study may be reversed. Pediatrics 2005;116:e34-e42. URL: www.pediatrics.org/cgi

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Access to Health Care for Children With Special Health Care Needs

Cited by 353 publications

References 17 publications

Barriers to administering non-oral formulations in a paediatric population: A semi-structured interview study

Barriers to administering non-oral formulations in a paediatric population: A semi-structured interview study

Unmet Dental Care Needs Among Children With Special Health Care Needs: Implications for the Medical Home

Effects of the State Children's Health Insurance Program Expansions on Children With Chronic Health Conditions

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