Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e940-e947 (doi:10.1542/peds.2008-2921)
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SPECIAL ARTICLE

The Future of Health Insurance for Children With Special Health Care Needs

Paul W. Newacheck, DrPHa,b, Amy J. Houtrow, MD, MPHa, Diane L. Romm, PhDc, Karen A. Kuhlthau, PhDc, Sheila R. Bloom, MSc, Jeanne M. Van Cleave, MDc and James M. Perrin, MDc

a Department of Pediatrics
b Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, California
c Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts

CONTEXT. Because of their elevated need for services, health insurance is particularly important for children with special health care needs. In this article we assess how well the current system is meeting the insurance needs of children with special health care needs and how emerging trends in health insurance may affect their well-being.

METHODS. We begin with a review of the evidence on the impact of health insurance on the health care experiences of children with special health care needs based on the peer-reviewed literature. We then assess how well the current system meets the needs of these children by using data from 2 editions of the National Survey of Children With Special Health Care Needs. Finally, we present an analysis of recent developments and emerging trends in the health insurance marketplace that may affect this population.

RESULTS. Although a high proportion of children with special health care needs have insurance at any point in time, nearly 40% are either uninsured at least part of the year or have coverage that is inadequate. Recent expansions in public coverage, although offset in part by a contraction in employer-based coverage, have led to modest but significant reductions in the number of uninsured children with special health care needs. Emerging insurance products, including consumer-directed health plans, may expose children with special health care needs and their families to greater financial risks.

CONCLUSIONS. Health insurance coverage has the potential to secure access to needed care and improve the quality of life for these children while protecting their families from financially burdensome health care expenses. Continued vigilance and advocacy for children and youth with special health care needs are needed to ensure that these children have access to adequate coverage and that they fare well under health care reform.

Key Words: insurance • access to care • quality of care • utilization • expenditures • special health care needs

Abbreviations: CSHCN—children with special health care needs • NSCSHCN—National Survey of Children With Special Health Care Needs • SCHIP—State Children's Health Insurance Program • FPL—federal poverty level • PPO—preferred provider organizations • HMO—health maintenance organization • CDHP—consumer-directed health plan

Accepted Jan 8, 2009.


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