Inequities In Health Care Needs For Children With Medical Complexity

Abstract

Children with special health care needs are believed to be susceptible to inequities in health and health care access. Within the group with special needs, there is a smaller group of children with medical complexity: children who require medical services beyond what is typically required by children with special health care needs. We describe health care inequities for the children with medical complexity compared to children with special health care needs but without medical complexity, based on a secondary analysis of the 2005–06 and 2009–10 National Survey of Children with Special Health Care Needs. The survey examines the prevalence, health care service use, and needs of children and youth with special care needs, as reported by their families. The inequities we examined were those based on race or ethnicity, primary language in the household, insurance type, and poverty status. We found that children with medical complexity were twice as likely to have at least one unmet need, compared to children without medical complexity. Among the children with medical complexity, uninsured status was associated with more unmet needs than privately insured status. We conclude that medical complexity itself can be a primary determinant of unmet needs.

Poverty and Trends in Three Common Chronic Disorders

“…15,40,41 Past studies indicate that comorbidities can impact a child's overall health and functioning in daily life, and children with complex health conditions have higher rates of unmet need than other children with special health care needs. 43,44 They also have higher rates of emotional and behavioral problems and mental health disorders than other children. 45,46 Unmet needs are higher for children with special health care needs living in or near poverty compared with those living >400% the FPL, 44 and significant sociodemographic disparities exist.…”

“…43,44 They also have higher rates of emotional and behavioral problems and mental health disorders than other children. 45,46 Unmet needs are higher for children with special health care needs living in or near poverty compared with those living >400% the FPL, 44 and significant sociodemographic disparities exist. 47,48 Minority children have poorer access to care and have increased odds of suboptimal health.…”

Complex chronic conditions in children and adolescents: hospitalizations in Brazil, 2013

“…The hospital system does not make it obligatory to register secondary causes; which could allow for the identification of other CCC cases. Kuo et al 18 analyzed combined data from 2005-06 and 2009-10 of an American national survey made by telephone interviews and found a CCC estimated prevalence of 2.7%. This survey also identified a higher proportion among men and among children under the age of six years.…”

Hospital Use in the Last Year of Life for Children With Life-Threatening Complex Chronic Conditions

“…Having multiple conditions may escalate hospital use and heighten health inequities. 8,[21][22][23][24] In this context, current investigation into the hospital experience for children with LT-CCCs in the last year of life is warranted. This multicenter study (1) describes the characteristics, hospital use, and costs for children with LT-CCCs in the last year of life, (2) compares resource use by type and number of conditions, and (3) examines major medical interventions received in the terminal admission.…”