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PEDIATRICS Vol. 113 No. 2 February 2004, pp. e109-e115

ELECTRONIC ARTICLE

Unmet Need for Routine and Specialty Care: Data From the National Survey of Children With Special Health Care Needs

Michelle L. Mayer, PhD, MPH, RN*,{ddagger}, Asheley Cockrell Skinner, BS{ddagger} and Rebecca T. Slifkin, PhD

* Cecil G. Sheps Center for Health Services Research
{ddagger} Department of Health Policy and Administration, University of North Carolina, Chapel Hill, North Carolina

Objective. To assess the prevalence of unmet needs for routine and specialty care among children with special health care needs (CSHCN) and to identify factors associated with the likelihood of having unmet need for medical care.

Methods. Data come from the respondents for 38 866 children interviewed for the National Survey of Children With Special Health Care Needs. Bivariate analyses were used to assess differences in unmet need for medical care by various environmental, predisposing, enabling, and need factors. Logit analyses were used to determine independent effects of these variables on the likelihood of having an unmet need for medical care.

Results. Nationally, 74.4% and 51.0% of CSHCN needed routine and subspecialty physician care, respectively. Of those reporting that they needed routine care, 3.2% were unable to obtain these services. Of those reporting a need for specialty care, 7.2% reported not obtaining all needed specialty care. The prevalence of unmet need for specialty care significantly exceeded the prevalence of unmet need for routine care. In logit analyses, African American children and children whose mothers had less than a high-school education faced twice the odds of having an unmet need for routine care. Compared with nonpoor children, children living below the federal poverty level were significantly more likely to have an unmet need for routine (adjusted odds ratio [aOR]: 1.97; 95% confidence interval [CI]: 1.23–3.14) and specialty (aOR: 2.50; 95% CI: 1.49–4.18) care. Near-poor children were also significantly more likely than nonpoor children to have unmet needs for routine and specialty care. Uninsured children were significantly more likely than continuously insured children to report an unmet need for routine (aOR: 7.51; 95% CI: 4.99–11.30) and specialty (aOR: 4.29; 95% CI: 2.99–6.15) care. Our findings also show that higher levels of general pediatrician supply, relative to the pediatric population, are associated with a significantly lower likelihood of having an unmet need for routine care. Likewise, a greater supply of pediatric subspecialists is associated with a decreased likelihood of having an unmet need for specialty care.

Conclusions. Compared with previous reports of the general pediatric population, CSHCN have higher levels of unmet need for medical services. Our regression results emphasize that children vulnerable because of their social circumstances (eg, poverty, etc) have significantly greater odds of having unmet need for routine and specialty physician care. Furthermore, our findings highlight the importance of insurance coverage in ensuring access to needed routine and specialty medical services.

Key Words: children • chronic conditions • special health care needs • access to care • utilization

Abbreviations: CSHCN, children with special health care needs • MSA, metropolitan statistical area • SCHIP, State Children’s Health Insurance Program • OR, odds ratio

Received for publication May 28, 2003; Accepted Oct 10, 2003.




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