Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009–2010

Ghandour, Reem M.; Comeau, Meg; Tobias, Carol; Dworetzky, Beth; Hamershock, Rose; Honberg, Lynda; Mann, Marie Y.; Bachman, Sara S.

doi:10.1016/j.acap.2015.02.002

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…This finding is consistent with previous research that has documented an increase in adequate insurance levels among publicly insured children. 27 , 28 This could be due to Medicaid and CHIP Reauthorization Act of 2009 (CHIPRA). However, we found that children with public insurance were less likely to have consistent health insurance coverage compared to children with private health insurance.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Differences in Health Insurance Adequacy and Consistency among Children: Evidence from the 2011/12 National Survey of Children's Health

Soylu

Elashkar

Aloudah

et al. 2018

Journal of Public Health Research

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BackgroundSurveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children’s (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months).Design and methodsWe used data from the 2011/2012 National Survey of Children’s Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups.ResultsStratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage.ConclusionsThis study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations.Significance for public healthAs the number of minority US children increases, monitoring racial/ethnic differences in health insurance coverage becomes critical in creating insurance programs that can provide adequate and consistent coverage. Using a nationally representative sample, the findings of this study suggest that low income and poor maternal health can adversely affect insurance consistency and adequacy for both minority and white children. This indicates that research studies on inequalities of healthcare coverage should also focus on underserved white populations of children as their insurance coverage is affected by similar factors as those for minority children. Elimination of inequalities may require targeted interventions that include the well-being of the entire family, cross-cultural education of healthcare providers, policy changes to grant low-income children with appropriate and reliable health insurance, and an ongoing monitoring of disparities by health plans.

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Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Differences in Health Insurance Adequacy and Consistency among Children: Evidence from the 2011/12 National Survey of Children's Health

Soylu

Elashkar

Aloudah

et al. 2018

Journal of Public Health Research

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“…The authors emphasized that both national and state policy efforts will be required to achieve the goal of all children with special health needs to have continuous and adequate health insurance coverage to meet their needs. 35 The results of research conducted in seven European countries on school inclusion policies for children with disabilities due to cerebral palsy showed that 46% of the children were in special classes or schools, although the educational policy of those countries was favorable to inclusion in regular schools. Children with more severe disabilities were rarely included in regular schools and visually impaired children attended special schools in all countries.…”

Section: Social Rights Of Children With Chronic Conditionsmentioning

confidence: 99%

Social rights of children with chronic conditions: a critical analysis of brazilian public policies

2017

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Direitos sociais das crianças com condições crônicas: análise crítica das políticas públicas brasileirasDerechos sociales de los niños con condiciones crónicas: análisis crítico de las políticas públicas brasileñas políticas relacionadas à atenção às crianças com doença crônica e pessoas com deficiência nos âmbitos dos direitos humanos, saúde, assistência social e educação. Foi realizada análise crítica do discurso de três legislações selecionadas. Resultados: As crianças com condições crônicas são contempladas nas legislações pela representação de crianças com doenças crônicas ou com deficiências. Verificam-se discursos do modelo social da deficiência, da criança e da pessoa com deficiência como sujeitos de direitos, da responsabilidade do estado na garantia de direitos sociais e da corresponsabilidade da família. Evidenciaram-se discursos associadas à ideologia de direitos humanos em conflito com a ideologia de normalização. Conclusão: As ações definidas para esse grupo são incipientes e com indícios de restrição de financiamento, revelando lutas ideológicas. Palavras-chave:Crianças com deficiência; Doença crônica; Seguridade Social; Defesa da Criança e do Adolescente; Enfermagem Pediátrica. resumenObjetivo: Analizar las políticas públicas brasileñas actuales que aseguran los derechos sociales de los niños con condiciones crónicas, en las áreas de salud, asistencia social y educación. Método: Investigación documental de las legislaciones que configuran políticas relacionadas a la atención de los niños con enfermedad crónica y personas con discapacidad en los ámbitos de los derechos humanos, salud, asistencia social y educación. Se realizó un análisis crítico del discurso de tres legislaciones seleccionadas. Resultados: Las legislaciones contemplan a los niños con condiciones crónicas mediante la representación de niños con enfermedades crónicas o con discapacidades. Se verifican discursos del modelo social de la discapacidad, del niño y de la persona con discapacidad como sujetos de derechos, de la responsabilidad del estado para garantizarles los derechos sociales y de la corresponsabilidad de la familia. Se evidenciaron también discursos asociados a la ideología de derechos humanos en conflicto con la ideología de regulación. Conclusión: Las acciones definidas para ese grupo son todavía incipientes y se notan indicios de financiación limitada, revelando luchas ideológicas.

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“…11 Because the largest share of CYSHCN are covered under employer-sponsored health insurance, increases in out-of-pocket expenditures may be associated with the move to VBP for families of CYSHCN. 6 …”

Section: Employer Originsmentioning

confidence: 99%

“…41 Moreover, family financial hardship is already a critically important issue among families of CYSHCN. 6 There are few protections for this specific type of health inequity, and VBP will not mitigate the problem of family financial hardship as a result of a child's special health care need.…”

Section: Vbp and Health Care Inequitiesmentioning

confidence: 99%

“…Although the total percentage of CYSHCN who are insured has stayed relatively stable over the past 10 years, the source of their coverage has shifted significantly from private to public coverage. 6 In the same survey from 2009/2010, 52.4% had private insurance, 35.9% had Medicaid or Children's Health Insurance Plan, roughly 8% had private insurance as their primary source of coverage and Medicaid as a secondary source, and 3.6% were uninsured at the time of the survey. These data predate the full implementation of the ACA.…”

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confidence: 99%

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Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs

2017

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There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs. We provide a history and definition of VBP and insurance design, noting its origin in employer-sponsored health insurance, and discuss various financing and payment strategies that may be pursued under a VBP framework. The relevance of these approaches for CYSHCN is discussed, and recommendations for next steps are provided. There is considerable work to be done if VBP strategies are to be applied to CYSHCN. Issues include the low prevalence of specific special health care need conditions, how to factor in a life course perspective, in which investments in children's health pay off over a long period of time, the marginal savings that may or may not accrue, the increased risk of family financial hardship, and the potential to exacerbate existing inequities across race, class, ethnicity, functional status, and other social determinants of health.

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Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009–2010

Cited by 16 publications

References 21 publications

Racial/Ethnic Differences in Health Insurance Adequacy and Consistency among Children: Evidence from the 2011/12 National Survey of Children's Health

Racial/Ethnic Differences in Health Insurance Adequacy and Consistency among Children: Evidence from the 2011/12 National Survey of Children's Health

Social rights of children with chronic conditions: a critical analysis of brazilian public policies

Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs

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