Published online October 12, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. 1273-1280 (doi:10.1542/peds.2009-0372)
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ARTICLE

Progress in Ensuring Adequate Health Insurance for Children With Special Health Care Needs

Lynda E. Honberg, MHSAa, Michael D. Kogan, PhDa, Deborah Allen, ScDb, Bonnie B. Strickland, PhDa and Paul W. Newacheck, DrPHc

a Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
b Bureau of Child, Adolescent and Family Health, Boston Public Health Commission, Boston, Massachusetts
c Institute for Health Policy Studies and Department of Pediatrics, University of California at San Francisco, San Francisco, California

OBJECTIVE: This article reports findings from the 2005–2006 National Survey of Children With Special Health Care Needs (NS-CSHCN) regarding the extent to which CSHCN have access to public or private health insurance that meets their needs.

METHODS: The HRSA Maternal and Child Health Bureau's health insurance core outcome was measured on the basis of whether a child had public or private coverage at the time of survey; continuity of coverage during the previous 12 months; and adequacy of coverage. Bivariate and multivariate statistical methods were used to assess independent predictors of respondents who met the health insurance core outcome and the impact of meeting the core outcome on measures of access and financial burden. Comparisons with a referent sample of children who did and did not have special needs and were included in the 2001 NS-CSHCN are also presented.

RESULTS: A total of 62.0% of CSHCN nationally met the health insurance core outcome in 2005–2006, up from 59.6% in 2001. Disparities by ethnicity and income remain, but some have narrowed, especially for Hispanic CSHCN. Children who did not meet the health insurance core outcome were more likely to have unmet needs and their families to experience financial problems. CSHCN were more likely to be insured than children without special needs but less likely to be adequately insured.

CONCLUSIONS: Results of the survey demonstrate that although a growing number of CSHCN have continuous and adequate health insurance, additional effort is needed to improve the adequacy of that insurance, particularly for children in vulnerable subpopulations.

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

Abbreviations: HRSA—Health Resources and Services Administration • MCHB—Maternal and Child Health Bureau • CSHCN—Children with Special Health Care Needs • NS-CSHCN—National Survey of Children with Special Health Care Needs • FPL—federal poverty level • CHIP—Children's Health Insurance Program • FOA—Family Opportunity Act

Accepted Jun 4, 2009.


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