Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1162-1169 (doi:10.1542/peds.2004-2432)
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Association Between Underinsurance and Access to Care Among Children With Special Health Care Needs in the United States

Michael D. Kogan, PhD*, Paul W. Newacheck, DrPH{ddagger}, Lynda Honberg, MHSA* and Bonnie Strickland, PhD*

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

Objective. To examine the impact of underinsurance on access to care among children with special health care needs (CSHCN) in the United States.

Methods. Interviews were conducted by telephone with the families of 38866 CSHCN who were younger than 18 years using the 2001 National Survey of Children With Special Health Care Needs. The prevalence of underinsurance and its relationship to access to care and family financial problems was examined in this cross-sectional analysis. CSHCN were classified as underinsured when coverage was deemed inadequate to meet the child's needs.

Results. An estimated 12.8% of US children experienced a special health care need in 2001. Although 95% of CSHCN had some type of insurance coverage at the time of the interview, 32% were classified as underinsured. Underinsured CSHCN were disproportionately represented in low-income families and were significantly more likely than fully insured children to have unmet health needs, and their families were more likely to report difficulty in obtaining specialty referrals, experience financial problems, and report that the child's condition caused family members to reduce or stop work. Underinsured CSHCN seemed to be somewhat better off than CSHCN with no insurance coverage on these measures.

Conclusions. Underinsured CSHCN represent an important and largely hidden underserved population.

Key Words: children with special health care needs • disability • national estimates • insurance • underinsurance • access to care

Abbreviations: CSHCN, children with special health care needs • MCHB, Maternal and Child Health Bureau

Accepted Jan 24, 2005.




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