A National Profile of Health Care Utilization and Expenditures for Children With Special Health Care Needs

Newacheck, Paul W.; Kim, Sue E.

doi:10.1001/archpedi.159.1.10

Cited by 402 publications

(273 citation statements)

References 13 publications

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“…Although ϳ14% of children in the United States have special health care needs, 2 this group accounts for 42% of the medical expenditures for children. 3 Moreover, underinsurance among CSHCN has been associated with increased risks for lacking a personal doctor or nurse, having unmet health needs, reporting difficulty in obtaining specialty referrals, and experiencing financial problems. 4 An estimated one third of CSHCN nationally are underinsured.…”

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confidence: 99%

State Variation in Underinsurance Among Children With Special Health Care Needs in the United States

Kogan

Newacheck²,

Blumberg

et al. 2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Many studies have documented the extent to which CSHCN lack insurance. Less attention has been devoted to examining underinsurance for this population and no studies have examined state variability in underinsurance. WHAT THIS STUDY ADDS:We demonstrate that underinsurance affects far more CSHCN than does lack of insurance. Our results indicate that where a child lives is strongly related to the likelihood that his or her health insurance is adequate. abstract OBJECTIVE: National attention has focused on providing health insurance coverage for children. Less awareness has been given to underinsurance, particularly for children with special health care needs (CSHCN). Defined as having inadequate benefits, underinsurance may be a particular problem for CSHCN because of their greater needs for medical care. METHODS:We used the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative study of Ͼ40 000 CSHCN, to address state variations in underinsurance. CSHCN with health insurance were considered underinsured when a parent reported that the child's insurance did not usually or always cover needed services and providers or reasonably cover costs. We calculated the unadjusted prevalence of underinsurance for each state. Using logistic regression, we estimated state-specific odds and prevalence for underinsurance after adjusting for poverty level, race/ethnicity, gender, family structure, language use, insurance type, and severity of child's health condition. We also conducted multilevel analyses incorporating state-level contextual data on Medicaid and the State Children's Health Insurance Program. RESULTS: Bivariate and multivariate analyses indicated that CSHCNЈs state of residence had a strong association with insurance adequacy. State-level unadjusted underinsurance rates ranged from 24% (Hawaii) to 38% (Illinois). After multivariate adjustments, the range was largely unchanged: 23% (Hawaii) to 38% (New Jersey). Multilevel analyses indicated that Medicaid income eligibility levels were inversely associated with the odds of being underinsured. CONCLUSIONS: The individual-level and macro-level factors examined only partly explain state variations in underinsurance. Furthermore, the macro-level factors explained only a small portion of the variance; however, other macro-level factors may be relevant for the observed patterns.

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confidence: 99%

State Variation in Underinsurance Among Children With Special Health Care Needs in the United States

Kogan

Newacheck²,

Blumberg

et al. 2010

Pediatrics

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“…While many were attending this tertiary care institution for physiotherapy, the speech and occupational therapy services in the same facility were not utilized by them (Table 3). From non-governmental organizations 11 (2.9) *Percentages do not add up to 100 due to multiple responses* Children with special needs have a greater demand for health care than those without special needs (Szilagyi 2004, Newacheck andKim, 2005), resulting in increased health care costs. From our results it was evident that over 70% of the children with cerebral palsy belonged to economically deprived families and a considerable proportion (20%) of caregivers had given up their jobs to look after the child (Table 1).…”

Section: Discussionmentioning

confidence: 99%

A Profile of Children With Cerebral Palsy: Identifying Unmet Needs in Health and Social Care

Fernando¹,

Wannakukoralage²,

Athukorala³

et al. 2016

World Disability &Amp; Rehabilitation Conference

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Provision of care to a child with Cerebral Palsy (CP) requires individualized assessment and management of all associated problems. They need special education and their families need social support to face day-to-day demands of caregiving. We reviewed the characteristics of 375 children with CP attending Teaching Hospital, Karapitiya to identify their health problems and current level of health and social care utilization. Data were collected through questionnaire-based interviews with caregivers or extracted from child's medical records. The results revealed that approximately 2/3 rd of the children had spastic quadriplegic CP and 54% had some co-morbidity. The majority (30.9%) had 3-4 functional problems. Problems with mobility (77.6%), social activities of daily living (69.3%), bladder/bowel function (70.4%) and speech (57.9%) were the common functional problems. Learning difficulties were reported in 29.3%. Nearly 17% had behavioural and emotional problems. Approximately 98% of the children received physiotherapy. Despite higher numbers having problems with speech and activities of daily living, only 48% received speech therapy and less than 10% received occupational therapy. Among pre-school and school age children, over 70% had never attended school. Only 17.2% of school attendees received special education. Although nearly 70% was from rural, low socio-economic backgrounds, only 12.8% received any form of external financial support. We conclude that children with CP and their families have many unmet needs in the areas of therapy, special education and social support. These needs should be addressed adequately in developing long-term care plans for children with CP, in order to achieve better outcomes.

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“…CSHCN have health care expenses that are 3 times higher than other children. 9 Although they represent approximately 15% of the population, CSHCN account for 33.6% or more of total health care costs attributable to children. [9][10][11] CSHCN also have 4 times the number of hospitalizations, twice as many physician visits, 1.5 times as many emergency department (ED) visits, and receive 5 times the number of prescriptions.…”

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confidence: 99%

“…9 Although they represent approximately 15% of the population, CSHCN account for 33.6% or more of total health care costs attributable to children. [9][10][11] CSHCN also have 4 times the number of hospitalizations, twice as many physician visits, 1.5 times as many emergency department (ED) visits, and receive 5 times the number of prescriptions. 9 Reflecting the impact of higher health care utilization and costs, approximately 40% of families of CSHCN experience burdensome out-ofpocket expenses even when they are eligible for safety net programs.…”

mentioning

confidence: 99%

“…[9][10][11] CSHCN also have 4 times the number of hospitalizations, twice as many physician visits, 1.5 times as many emergency department (ED) visits, and receive 5 times the number of prescriptions. 9 Reflecting the impact of higher health care utilization and costs, approximately 40% of families of CSHCN experience burdensome out-ofpocket expenses even when they are eligible for safety net programs. 12,13 Prior literature has described health care costs and utilization for CSHCN, but has not examined the impact of SDM on these outcomes.…”

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confidence: 99%

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Shared Decision-Making and Health Care Expenditures Among Children With Special Health Care Needs

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Children with special health care needs (CSHCN) account for more than one-third of pediatric health care costs. Little is known regarding the impact of shared decision-making (SDM) over time on child health care expenditures and utilization. WHAT THIS STUDY ADDS:In a national sample, we found that increasing SDM was associated with decreased health care costs and utilization for CSHCN. Results support prospective studies to determine if pediatric interventions to foster SDM reduce the financial burden of caring for CSHCN. abstract BACKGROUND AND OBJECTIVES: To understand the association between shared decision-making (SDM) and health care expenditures and use among children with special health care needs (CSHCN). METHODS:We identified CSHCN ,18 years in the 2002-2006 Medical Expenditure Panel Survey by using the CSHCN Screener. Outcomes included health care expenditures (total, out-of-pocket, office-based, inpatient, emergency department [ED], and prescription) and utilization (hospitalization, ED and office visit, and prescription rates). The main exposure was the pattern of SDM over the 2 study years (increasing, decreasing, or unchanged high or low). We assessed the impact of these patterns on the change in expenditures and utilization over the 2 study years.RESULTS: Among 2858 subjects representing 12 million CSHCN, 15.9% had increasing, 15.2% decreasing, 51.9% unchanged high, and 17.0% unchanged low SDM. At baseline, mean per child total expenditures were $2131. Over the 2 study years, increasing SDM was associated with a decrease of $339 (95% confidence interval: $21, $660) in total health care costs. Rates of hospitalization and ED visits declined by 4.0 (0.1, 7.9) and 11.3 (4.3, 18.3) per 100 CSHCN, and office visits by 1.2 (0.3, 2.0) per child with increasing SDM. Relative to decreasing SDM, increasing SDM was associated with significantly lower total and out-of-pocket costs, and fewer office visits. CONCLUSIONS:We found that increasing SDM was associated with decreased utilization and expenditures for CSHCN. Prospective study is warranted to confirm if fostering SDM reduces the costs of caring for CSHCN for the health system and families.

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A National Profile of Health Care Utilization and Expenditures for Children With Special Health Care Needs

Cited by 402 publications

References 13 publications

State Variation in Underinsurance Among Children With Special Health Care Needs in the United States

State Variation in Underinsurance Among Children With Special Health Care Needs in the United States

A Profile of Children With Cerebral Palsy: Identifying Unmet Needs in Health and Social Care

Shared Decision-Making and Health Care Expenditures Among Children With Special Health Care Needs

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