Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1233-1239 (doi:10.1542/peds.2004-1503)

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Assuring Adequate Health Insurance: Results of the National Survey of Children With Special Health Care Needs

Lynda Honberg, MHSA^*, Merle McPherson, MD, MPH^*, Bonnie Strickland, PhD^*, Julia C. Gage, MPH^*, Paul W. Newacheck, DrPH

^* Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
Institute for Health Policy Studies and Department of Pediatrics, University of California, San Francisco, California

Objective. The purpose of this article is to report the findings of the 2001 National Survey of Children With Special Health Care Needs regarding the extent to which children with special health care needs (CSHCN) have access to public or private health insurance that meets their needs.

Methodology. As part of its effort to develop systems of care for CSHCN, the US Maternal and Child Health Bureau established a health insurance core outcome. Successful attainment was measured on the basis of whether the child met 3 distinct components at the time of the interview: presence of public or private coverage; continuity of coverage over the previous 12 months; and adequacy of coverage. Adequacy of coverage was measured from the family's perspective of whether their insurance covered needed services, covered a reasonable share of costs, and allowed families to see the providers they felt were best for their child. Bivariate and multivariate statistical methods were used to assess independent predictors of respondents meeting the health insurance core outcome.

Results. Results of the survey indicated that 59.6% of CSHCN nationally met the health insurance core outcome using the 3 components of presence of insurance coverage, continuity of coverage, and adequacy of coverage. Poverty status, race/ethnicity, and functional ability were significant factors in whether a child met the health insurance core outcome as well as each of the 3 components. Of Hispanic and non-Hispanic black CSHCN, 45.2% and 57.6%, respectively, met the health insurance core outcome, compared with 62.5% of their white counterparts. Children with the most limited functional ability were 50% less likely to meet the health insurance core outcome than CSHCN without limitations. More than 10% of Hispanic CSHCN were uninsured at the time of the interview, and 20% of Hispanic CSHCN experienced gaps in coverage. Although insurance met the needs of most families, more than one fourth of families reported that uncovered costs were not reasonable. Children who did not meet the health insurance core outcome were also more likely to have unmet needs.

Conclusions. Results of the survey demonstrated that although the majority of CSHCN have adequate health insurance, additional work is needed to improve the adequacy of insurance, particularly for children below the poverty line, Hispanic children, and children with the most limited functional ability. The survey results also demonstrated the importance of continuous and adequate health insurance, because children who met the health insurance core outcome had fewer unmet needs.

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Key Words: children with special health care needs • adequate health insurance • National Survey of Children With Special Health Care Needs

Abbreviations: SCHIP, State Children's Health Insurance Program • CSHCN, children with special health care needs • MCHB, US Maternal and Child Health Bureau • OR, odds ratio • CI, confidence interval • FPL, federal poverty level

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Accepted Jan 7, 2005.

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