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PEDIATRICS Vol. 112 No. 3 September 2003, pp. 593-603

Utilization of Medical and Health-Related Services Among School-Age Children and Adolescents With Special Health Care Needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data)

Wendy E. Weller, PhD*, Cynthia S. Minkovitz, MD, MPP{ddagger} and Gerard F. Anderson, PhD§

* Department of Health Policy, Management, and Behavior, University at Albany, State University of New York, Albany, New York
{ddagger} Department of Population and Family Health Sciences
§ Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Objective. To determine how sociodemographic factors and type of insurance influence use of medical and health-related services by children with special health care needs (CSHCN), after controlling for need.

Methods. A cross-sectional analysis of 1994 National Health Interview Disability Survey was conducted. Children between 5 and 17 years were identified as chronically ill according to the Questionnaire for Identifying Children with Chronic Conditions (n = 3061). Independent variables included child and family characteristics categorized as predisposing, enabling, and need. Dependent variables included use of 4 medical or 7 health-related services.

Results. Most children (88.7%) had seen a physician; 23.9% had an emergency department visit, 11.4% had a mental health outpatient visit, and 6.4% were hospitalized. Health-related service use ranged from <5.0% (transportation and social work) to 65.1% (medical care coordination); 20% to 30% of children used the remaining services (therapeutic, assistive devices, nonmedical care coordination, housing modifications). In fully adjusted logistic models, children with public insurance were significantly more likely than privately insured children to use 2 of the 4 medical services and 5 of the 7 health-related services. Non-Hispanic black children and children from less educated families were significantly less likely to use many of the services examined.

Conclusions. In 1994, factors in addition to need influenced medical and health-related service use by CSHCN. Differences in the scope of benefits covered by public insurance compared with private insurance may influence utilization of medical and especially health-related services. Attention is needed to ensure that CSHCN who are racial/ethnic minorities or are from less educated families have access to needed services. Future studies should determine whether these patterns have changed over time.

Key Words: children with special health care needs • health services • utilization

Abbreviations: CSHCN, children with special health care needs • NHIS, National Health Interview Survey • NHIS-D, National Health Interview Survey on Disability • QuICCC, Questionnaire for Identifying Children with Chronic Conditions • MH/SA, mental health/substance abuse

Received for publication Oct 14, 2002; Accepted Feb 13, 2003.




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