The Impact of Insurance on Satisfaction and Family-Centered Care for CSHCN

Abstract

BACKGROUND:Children with special health care needs (CSHCN) have worse health outcomes and satisfaction compared with children with typical needs. Although individual characteristics influence satisfaction and family-centered care, additional effects of health insurance and state child health policies are unknown. OBJECTIVES:To determine if satisfaction and family-centered care varied among CSHCN, after adjusting for individual characteristics, according to insurance type and state child health policies. METHODS:We performed descriptive and multivariate analyses by using demographic, insurance, and satisfaction data from the 2006 National Survey of Children With Special Health Care Needs (N ϭ 40 723). Additional state data included Medicaid and State Children's Health Insurance Program (SCHIP) characteristics and the supply of pediatricians. We supplemented the national findings with survey data from Florida's SCHIP comprehensive care program (CMS-Duval ["Ped-ICare"]) for CSHCN (N ϭ 300). RESULTS:Nationally, 59.8% of parents were satisfied with their child's health services, and two thirds (65.7%) received family-centered care. Adjusting for individual predictors, those uninsured and those with public insurance were less satisfied (odds ratios [ORs]: 0.45 and 0.83, respectively) and received less family-centered care (ORs: 0.43 and 0.80, respectively) than privately insured children. Of note, satisfaction increased with state Medicaid spending. Survey data from Ped-I-Care yielded significantly higher satisfaction (91.7%) compared with national levels of satisfaction in the SCHIP (54.2%) and similar rates of family-centered care (65.6%). These results suggest that satisfaction is based more on experiences with health systems, whereas familycentered care reflects more on provider encounters. CONCLUSIONS:Insurance type affects both satisfaction and familycentered care for CSHCN, and certain state-level health care characteristics affect satisfaction. Future studies should focus on interventions in the health care system to improve satisfaction and patient encounters for family-centered care. Pediatrics 2009;124:S420-S427

Medical Home Disparities Between Children With Public and Private Insurance

“…Public versus private insurance has been shown to be associated with less family-centered care in one study of children with special health care needs, 32 but another study found no association. 33 The public-private disparity in FCC found here has several potential explanations.…”

Clarifying the Predictive Value of Family‐Centered Care and Shared Decision Making for Pediatric Healthcare Outcomes Using the Medical Expenditure Panel Survey

“…Covariates were identified as predisposing characteristics, enabling resources, or health care need factors according to previous FCC/SDM research (Bethell, Read, and Brockwood 2004;Denboba et al 2006;Thompson et al 2009;Coker, Rodriguez, and Flores 2010;Fiks et al 2010Fiks et al , 2012aGuerrero et al 2010;Kuo, Bird, and Tilford 2011;Kuo, Frick, and Minkovitz 2011;Raphael et al 2011;Romaire, Bell, and Grossman 2012a,b;Smalley et al 2014;Strickland et al 2014). Covariates used to characterize the study sample and controlled for in multivariable analysis included child age, sex, race/ethnicity, primary household language, household income relative to the federal poverty level (FPL), highest parent education level, census region, urbanness (i.e., metropolitan statistical region vs. nonmetropolitan statistical region), health insurance status and type, special health care needs status assessed by the CSHCN Screener (Bethell et al 2002a,b), illness/injury care need(s), specialty care need, and overall health status (Appendix SA2).…”

Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study

“…The use of family expertise is essential to improving health care delivery [13]. However, only a few studies have engaged low-income, minority and/or non-English speaking families in this process to understand their perspective [14][15][16]. Some issues that families have previously identified were a lack of awareness of community resources, fragmented service lines, and provider organizations varying in their ability to meet linguistic and cultural needs of different individuals and families [17][18][19][20][21][22].…”