The Future of Health Insurance for Children With Special Health Care Needs

Newacheck, Paul W.; Houtrow, Amy J.; Romm, Diane; Kuhlthau, Karen; Bloom, Sheila R.; Cleave, Jeanne M Van; Perrin, James M.

doi:10.1542/peds.2008-2921

Cited by 29 publications

(14 citation statements)

References 59 publications

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“…Past studies have demonstrated that many of these factors or variables are statistically significant predictors of underinsurance, 4 and there is substantial variation in the prevalence of these variables across states. 18 Like previous studies, our analysis of the current data showed that underinsurance is more prevalent among vulnerable populations, including children with more significant functional limitations, those who live in poverty, and those in non-English-speaking households; however, our multivariate adjustment for these variables and others operating at the level of the child and family did not appreciably diminish state disparities in underinsurance.…”

Section: Discussionsupporting

confidence: 67%

“…If policy makers are interested in ensuring equitable treatment in the health care system for CSHCN, then policy initiatives aimed at reducing underinsurance and increasing uniformity of coverage across states are also needed. A recent report 18 showed that the sources of underinsurance vary by type of coverage, with inadequate coverage of needed services and providers being the primary source of underinsurance for publicly insured CSHCN and inadequate coverage of a reasonable amount of costs being the primary source of underinsurance for privately insured CSHCN. Hence, different approaches to addressing underinsurance in public and private plans may be needed.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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

Kogan

Newacheck²,

Blumberg

et al. 2010

Pediatrics

Self Cite

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“…Although children with chronic health problems have far higher-than-average costs, fewer than half received a dental visit during the year, and other research has documented that many experience unmet needs in Medicaid/CHIP. 31 Because such a large proportion of the high spenders have hospital stays and emergency room visits, states may be able to reduce the costs associated with stays and visits that could have been avoided if more timely and appropriate ambulatory care had been provided. 32,33 More research is needed on the root causes of spending in the upper deciles and how much reflects needed services rather than poor quality of care, medical errors, avoidable hospital and emergency room care due to delayed receipt of needed ambulatory services, and unnecessary care-all of which could in principle be addressed through programmatic changes.…”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Containing Costs And Improving Care For Children In Medicaid And CHIP

2009

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ABSTRACT:The current health reform debate is greatly concerned with "bending the curve" of cost growth and containing costs, particularly in public programs. Our research demonstrates that spending in Medicaid and the Children's Health Insurance Program (CHIP) is highly concentrated, particularly among children with chronic health problems. Ten percent of enrollees (two-thirds of whom have a chronic condition) account for 72 percent of the spending; 30 percent of enrolled children receive little or no care. These results highlight the importance of cost containment strategies that reduce avoidable hospitalizations among children with chronic problems and policies that increase preventive care, particularly among African American children. [Health Aff

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“…8 are designed to make enrollment easier and target hard-to-reach populations by simplifying and translating enrollment forms.…”

Section: Discussionmentioning

confidence: 99%

“…Statistically significant differences in prevalence at P Ͻ .05. in 2001 to 65.8% in 2005.12 Between 2001 and 2005-2006, the proportion of CSHCN who were covered by private insurance declined at an even more rapid rate, from 65.1% to 59.3% 8. In understanding the importance of the shift in public and private coverage, it is worth noting that contrary to prevailing assumptions, the 2005-2006 survey data show that publicly insured CSHCN are slightly more likely to achieve the health insurance core outcome than privately insured CSHCN.…”

mentioning

confidence: 99%