Originally published in MedPage Today
by Chris Emery, MedPage Today Contributing Writer
Nearly a third of children with special healthcare needs are underinsured, and where a child lives strongly influences whether he or she will have adequate healthcare coverage, a new study found.
The unadjusted proportion of underinsured special-needs children varied strongly by state, ranging from 24% in Hawaii (standard error=1.75) to 38% in Illinois (SE=2.13), found the study published online March 8 in Pediatrics. After adjusting for factors such as age, race, and poverty level, the proportion of children without adequate healthcare coverage ranged from 23% (SE=1.89) in Hawaii to 38% in New Jersey (SE=2.21).
“Our results indicate that where a child lives is strongly related to the likelihood that his or her health insurance is adequate,” Michael D. Kogan, PhD, of the Health Resources and Services Administration, and colleagues wrote. “Moreover, only a small part of that association is explained by the underlying demographic and health characteristics of children. These findings suggest that current efforts to add coverage incrementally for the uninsured, although important, will do little to address the problems of the underinsured or the state disparities demonstrated here.”
While considerable attention has recently focused on providing health insurance coverage for children who have none, much less attention has focused on the problem of underinsurance, according to the authors. In particular, they wrote, little attention has been given to children with special healthcare needs, who have chronic physical, developmental, behavioral, or emotional conditions — or are at high risk of these conditions — and require special services beyond what is normally required. Previous research has found that although 14% of children in the U.S. have special healthcare needs, they account for 42% of the medical expenditures for children.
The authors noted that focusing on underinsured children is useful for several reasons. First, “states are being called on to play a larger role in insuring their populations since the inception of the State Children’s Health Insurance Program (SCHIP) and the continuing shift away from employer-based health insurance.” In addition, “gaining additional understanding of the large state variations could lead to more effective interventions aimed at reducing disparities,” and “the best performing states can serve as benchmarks for what might be achieved by others.”
To determine the proportion of special needs children in each state, Kogan and colleagues analyzed data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative study of more than 40,000 children. Children were considered underinsured if a parent reported that the child’s insurance did not usually or always cover needed services and providers, or if the insurance did not reasonably cover costs.
Of the parents of special-needs children who responded to the survey, 12.7% reported that insurance did not offer benefits or cover services that met the child’s needs, 28.0% reported that the costs that were not covered by insurance were not reasonable, and 9.3% reported that the insurance did not allow the child to see the healthcare providers that he or she needed.
“Although there is perennial interest in the Census Bureau’s periodic reports on the number of uninsured individuals in the U.S., our analysis of the NS-CSHCN suggests that underinsurance affects far more children than does lack of insurance, at least among children with special healthcare needs,” the authors wrote.
Generally speaking, children living in Midwest states tended to have better coverage, while those living the Southwest had less coverage. Children with coverage from private insurers were more likely to be underinsured (33.5%) than those with public coverage (30.9%).
Children were also more likely to be underinsured if their parents had to cut back or stop working due to their condition, if they were between the ages 6 to 17 years, if they were poor, and if they lived in non–English-speaking households.
The authors cautioned that the study relied on parents’ assessment of their children’s healthcare status, which may have introduced recall bias into the findings, and that the study excluded children who were homeless or living in institutions.
“Also, because the focus of this study was underinsurance, states that provide less comprehensive public coverage to more children will seem to be ‘lower performing’ than states that provide more comprehensive public coverage to fewer children, because uninsured children were not considered ‘underinsured’ and were excluded from the analyses,” the researchers wrote.
Despite these limitations, the authors concluded that underinsurance is an large problem that remains to be addressed. “If policymakers are interested in ensuring equitable treatment in the healthcare system for children with special healthcare needs, then policy initiatives aimed at reducing underinsurance and increasing uniformity of coverage across states are also needed,” they wrote.
Visit MedPageToday.com for more pediatrics news.
