Published online January 8, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. e341-e347 (doi:10.1542/peds.2006-2218)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Oswald, D. P.
Right arrow Articles by Moore, M. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Oswald, D. P.
Right arrow Articles by Moore, M. B.
Related Collections
Right arrow Office Practice

ARTICLE

Underinsurance and Key Health Outcomes for Children With Special Health Care Needs

Donald P. Oswald, PhDa, Joann N. Bodurtha, MD, MPHb,c, Janet H. Willis, MPH, RDd and Melinda B. Moore, MAe

a Departments of Psychiatry
b Human Genetics
c Pediatrics
e Psychology
d Partnership for People with Disabilities, Virginia Commonwealth University, Richmond, Virginia

OBJECTIVE. The objective was to examine the relationship between underinsurance and other core outcomes for children with special health care needs.

METHODS. This study analyzed data from the National Survey of Children With Special Health Care Needs. Two alternative definitions of underinsurance, designated attitudinal and economic, were investigated. Logistic regression models in which the response variables were the child's status for each of the target core outcomes and underinsurance status was a dichotomous predictor variable were created. In addition to underinsurance status, 10 other predictor variables were included in the model.

RESULTS. Underinsurance is associated with the Maternal and Child Health Bureau core outcomes for children with special health care needs related to satisfaction with care and partnering with families in decision-making, access to a medical home, community-based service delivery that is easy to use, and access to services to make transitions to adulthood. In each case, children with special health care needs who were underinsured had significantly poorer outcomes than did children who were adequately insured.

CONCLUSIONS. Although these results cannot clarify the cause of poorer outcomes, there are clear negative effects associated with the problem of underinsurance. Inadequate health care coverage for children with special health care needs may save dollars in the short-term but, if other outcomes are compromised, then children, their families, and society at large may pay a price in the longer term.

Key Words: access to health care • child health services • special needs • health insurance coverage gaps

Abbreviations: MCHB—Maternal and Child Health Bureau • CSHCN—children with special health care needs • SCHIP—State Child Health Insurance Program

Accepted Sep 13, 2006.