Skip to main content

Advertisement

SpringerLink
Log in

Unmet Need, Cost Burden, and Communication Problems in SCHIP by Special Health Care Needs Status

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Children with special health care needs (CSHCN) require more health care than other children; hence adequate health insurance is critical. The Maternal and Child Health Bureau defined three components of adequacy: (1) coverage of needed benefits and services; (2) reasonable costs; and (3) ability to see needed providers. This study compares cost burden, access to care, and patient/provider communication within New Jersey’s SCHIP for CSHCN versus those without such needs. We used data from the 2003 NJ FamilyCare (NJFC) Supplement to the New Jersey Family Health Survey on 444 children enrolled in NJFC and 145 children disenrolled from NJFC but covered by other insurance at the time of the survey. The CSHCN Screener was used to identify CSHCN. CSHCN in NJFC had 1.5 times the odds of an unmet need for health care; 2.7 times the odds of a cost burden; and 2.2 times the odds of any coverage or service inadequacy than those without SHCN, even when demographic factors and NJFC plan level (which is based on income) were taken into account. CSHCN enrolled in NJFC have more difficulties in some areas of access to care and cost burden. Patterns of access to care, cost burden, and patient/provider communication were similar for children formerly in NJFC who had other types of insurance at the time of the survey. Future studies should use comprehensive measures of adequacy of coverage, including attitudinal, structural and economic perspectives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (2007) The national survey of children with special health care needs chartbook 2005–2006. Rockville, MD: U.S. Department of Health and Human Services. Available online at http://mchb.hrsa.gov/cshcn05/. Accessed November 2010.

  2. McPherson, M. P., Arango, P., Fox, H. B., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102, 137–140.

    Article  PubMed  CAS  Google Scholar 

  3. Brach, C., Lewit, E. M., VanLandeghem, K., Bronstein, J., Dick, A. W., Kimminau, K. S., et al. (2003). Who’s enrolled in the state children’s health insurance program (SCHIP)? An overview of findings from the child health research initiative (CHIRI). Pediatrics, 112, 499–507.

    Google Scholar 

  4. Maternal and Child Health Bureau (2010) Achieving and measuring success: A national agenda for children with special health care needs. Available online at http://mchb.hrsa.gov/programs/specialneeds/measuresuccess.htm. Accessed November 2010.

  5. Jeffrey, A. E., & Newacheck, P. W. (2006). Role of insurance for children with special health care needs: A synthesis of the evidence. Pediatrics, 118, 1027–1038.

    Article  Google Scholar 

  6. van Dyck, P. C., Kogan, M. D., McPherson, M. G., Weissman, G. R., & Newacheck, P. W. (2004). Prevalence and characteristics of children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 158, 884–890.

    Article  PubMed  Google Scholar 

  7. Newacheck, P. W., & Kim, S. E. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159, 10–17.

    Article  PubMed  Google Scholar 

  8. Davidoff, A. J. (2004). Insurance for children with special health care needs: Patterns of coverage and burden on families to provide adequate insurance. Pediatrics, 114, 394–403.

    Article  PubMed  Google Scholar 

  9. Honberg, L. E., Kogan, M. D., Allen, D., Strickland, B. B., & Newacheck, P. W. (2009). Progress in ensuring adequate health insurance for children with special health care needs. Pediatrics, 124, 1273–1280.

    Article  PubMed  Google Scholar 

  10. Newacheck, P. W., McManus, M., Fox, H. B., Hung, Y. Y., & Halfon, N. (2000). Access to health care for children with special health care needs. Pediatrics, 105, 760–766.

    Article  PubMed  CAS  Google Scholar 

  11. Macon, T. A., Miller, J. E., Gaboda, D., Simpson, T., & Cantor, J. (2007). Is there differential retention of children with special health care needs in SCHIP? Pediatrics, 120, e1217–e1224.

    Article  PubMed  Google Scholar 

  12. Shenkman, E., Vogel, B., Boyett, J. M., & Naff, R. (2002). Disenrollment and re-enrollment patterns in a SCHIP. Health Care Financing Review, 23, 47–63.

    PubMed  Google Scholar 

  13. Baruffi, G., Miyashiro, L., Prince, C. B., & Heu, P. (2005). Factors associated with ease of using community-based systems of care for CSHCN in Hawai’i. Maternal and Child Health Journal, 9(suppl), S99–S108.

    Article  PubMed  Google Scholar 

  14. Kogan, M. D., Newacheck, P. W., Honberg, L., & Strickland, B. (2005). Association between underinsurance and access to care among children with special health care needs in the United States. Pediatrics, 116, 1162–1169.

    Article  PubMed  Google Scholar 

  15. Smaldone, A., Honig, J., & Byrne, M. W. (2005). Delayed and forgone care for children with special health care needs in New York State. Maternal and Child Health Journal, 9(suppl), S75–S86.

    Article  PubMed  Google Scholar 

  16. Tippy, K., Meyer, K., Aronson, R., & Wall, T. (2005). Characteristics of coordinated ongoing comprehensive care within a medical home in Maine. Maternal and Child Health Journal, 9(suppl), S13–S21.

    Article  PubMed  Google Scholar 

  17. Kogan, M. D., Newacheck, P. W., Blumberg, S. J., Heyman, K. M., Strickland, B. B., Singh, G. K., et al. (2010). State variation in underinsurance among children with special health care needs in the United States. Pediatrics, 125, 673–680.

    Article  PubMed  Google Scholar 

  18. Szilagyi, P. G., Dick, A. W., Klein, J. D., Shone, L. P., Zwanziger, J., & McInerny, T. (2004). Improved access and quality of care after enrollment in the New York state children’s health insurance program (SCHIP). Pediatrics, 113(5), e395–e404.

    Article  PubMed  Google Scholar 

  19. Bethell, C. D., Read, D., & Brockwood, K. (2004). Using existing population-based data sets to measure the American Academy of pediatrics definition of medical home for all children and children with special health care needs. Pediatrics, 113(4 suppl):1529–1537.

    Google Scholar 

  20. Mulvihill, B. A., Altarac, M., Swaminathan, S., Kirby, R. S., Kulczycki, A., & Ellis, D. E. (2007). Does access to a medical home differ according to child and family characteristics, including special-health-care-needs status, among children in Alabama? Pediatrics, 119(1 suppl):S107–S113

  21. Szilagyi, P. G., Shenkman, E., Brach, C., LaClair, B. J., Swigonski, N., & Dick, A., et al. (2003). Children with special health care needs enrolled in the state children’s health insurance program (SCHIP): Patient characteristics and health care needs. Pediatrics, 112(E1 suppl):e508–e520.

    Google Scholar 

  22. Miller, J. E., Gaboda, D., Trail, T., & Cantor, J. C. (2005). Findings from the 2003 NJ family health survey-NJ familycare supplement. State of New Jersey, Department of Human Services.

  23. U.S. Census Bureau, Housing and Household Economic Statistics Division (2010) Poverty thresholds 2003. Available online at http://www.census.gov/hhes/www/poverty/data/threshld/thresh03.html. Accessed November 2010.

  24. Foundation for Accountability, Child and Adolescent Health Measurement Initiative (1998) The children with special health care needs (CSHCN) screener. Available online at http://www.markle.org/resources/facct/doclibFiles/documentFile_446.pdf. Accessed November 2010.

  25. Bethell, C. D., Read, D., Stein, R. E. K., et al. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2, 38–47.

    Article  PubMed  Google Scholar 

  26. VanLandeghem, K., Bonney, J., Brach, C., & Kretz, L. (2006). SCHIP enrollees with special health care needs and access to care. CHIRI™ Issue Brief No. 5. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Pub. No. 06-0051.

  27. Blumberg, S. J., Welch, E. M., Chowdhury, S. R., Upchurch, H. L., Parker, E. K., & Skalland, B. G. (2008). Design and operation of the national survey of children with special health care needs, 2005–2006. National Center for Health Statistics. Vital and Health Statistics, 1(45).

  28. Brick, J. M., Ferraro, D., & Strickler, T., et al. (2002). NSAF response rates. Urban Institute, National Survey of America’s Families, 2002 Methodology Series, Report No. 8. December 2003.

  29. State Health Access Data Assistance Center (SHADAC) (2010) Measuring the adequacy of coverage or underinsurance. University of Minnesota, School of Public Health. Available online at http://www.shadac.org/files/MeasureUnderinsurance.pdf. Accessed November 2010.

  30. Ward, A., Beebe, T. J., Blewett, L. A., & Smaida, S. (2002). Issues in defining and measuring adequacy of coverage. Minneapolis, MN: State Health Access Data Assistance Center.

    Google Scholar 

  31. Slaits National Survey of Children with Special Health Care Needs (2010) Survey instrument. Available online at http://www.cdc.gov/nchs/data/slaits/NSCSHCNIIEnglishQuest.pdf. Accessed November 2010.

  32. Oswald, D. P., Bodurtha, J. N., Broadus, C. H., Willis, J. H., Tlusty, S. M., Bellin, M. H., & McCall, B. R. (2005). Defining underinsurance among children with special health care needs: A Virginia sample. Maternal and Child Health Journal, 9(suppl):S67–S74.

    Google Scholar 

  33. SCHIP Enrollees With Special Health Care Needs and Access to Care CHIRI™ Issue Brief No. 5. AHRQ Publication No. 06-0051, August 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chiri/chiribrf5/chiribrf5.pdf. Accessed November 2010.

  34. Horner, D., Guyer, J., Mann, C., & Alker, J. (2009). The children’s health insurance program reauthorization act of 2009: Overview and summary. Washington, DC: Center for Children and Families, Georgetown University Health Policy Institute. Available at http://ccf.georgetown.edu/index/schipreauthorization. Accessed March 2011.

  35. CHIPRA Children’s Health Care Quality Measurement and Improvement Activities (2011) Agency for healthcare research and quality. Rockville, MD. Available online at http://www.ahrq.gov/chipra/. Accessed March 2011.

  36. United States House of Representatives Committees on Ways and Means, Energy and Commerce, and Education and Labor (2010) Health insurance reform at a glance: Guaranteed benefits. Press Release, March 20, 2010. Available online at http://docs.house.gov/energycommerce/GUARANTEED_BENEFITS.pdf. Accessed October 2010.

  37. Kaiser Family Foundation (2010) Focus on health reform: Summary of new health reform law. Menlo Park, CA. Available online at http://www.kff.org/healthreform/upload/8061.pdf. Accessed November 2010.

  38. Kaiser Family Foundation (2010) Focus on health reform: Summary of coverage provisions of the patient protection and affordable care act. Menlo Park, CA. http://www.kff.org/healthreform/upload/8023-R.pdf. Accessed November 2010.

Download references

Acknowledgments

This study was conducted in cooperation with the New Jersey Department of Human Services, which provided study data and invaluable advice. Partial funding for this project was provided by the U.S. Department of Health and Human Services, Health Services and Research Administration through a grant to the New Jersey Department of Human Services and Rutgers Center for State Health Policy, and by Project L/EARN through its funding from the National Institutes of Mental Health. The authors are solely responsible for the analyses and conclusions herein. We would like to thank Susan Brownlee for assistance with the survey design and implementation, and Louise Russell, Michelle Walsky and Heidi Smith for advice and assistance.

Conflict of interest

None of the authors have a conflict of interest.

Author information

Author notes

  1. Tamarie Macon

    Present address: Combined Program in Education and Psychology, University of Michigan, 610 E. University, Ann Arbor, MI, 48109, USA

Authors and Affiliations

  1. Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, USA

    Jane E. Miller & Tamarie Macon

  2. Center for State Health Policy, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA

    Dorothy Gaboda & Joel C. Cantor

  3. E.J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, 08901, USA

    Jane E. Miller & Joel C. Cantor

Authors
  1. Jane E. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamarie Macon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dorothy Gaboda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel C. Cantor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jane E. Miller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miller, J.E., Macon, T., Gaboda, D. et al. Unmet Need, Cost Burden, and Communication Problems in SCHIP by Special Health Care Needs Status. Matern Child Health J 16, 850–859 (2012). https://doi.org/10.1007/s10995-011-0805-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-011-0805-x

Keywords

Search

Navigation