Unmet Need for Routine and Specialty Care: Data From the National Survey of Children With Special Health Care Needs

Abstract

Compared with previous reports of the general pediatric population, CSHCN have higher levels of unmet need for medical services. Our regression results emphasize that children vulnerable because of their social circumstances (eg, poverty, etc) have significantly greater odds of having unmet need for routine and specialty physician care. Furthermore, our findings highlight the importance of insurance coverage in ensuring access to needed routine and specialty medical services.

Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

“…4 Specialty care use also varies, with lower rates of use among minorities, uninsured children, those with less than high school-educated parents, and children in low-income households regardless of insurance type. 1,[4][5][6][7] In addition, low-income families and less educated families report less perceived need for specialist visits even though they report their children have more severe functional limitations than higher-income parents. 8 Among CSHCN, care coordination has been identified as a potential mechanism to decrease unmet specialty care needs.…”

Supply and Utilization of Pediatric Subspecialists in the United States

“…However, the differences in supply were not associated with meaningful differences in child or family disease burden. There are geographic inequalities in the distribution of pediatric subspecialists in the United States [1][2][3][4][5] and Canada. 6 In the United States, 10% to 30% of children must travel .80 miles to access many pediatric subspecialists, including endocrinology, pulmonary, gastroenterology, nephrology, and developmental pediatrics.…”

“…2 Although inequalities in pediatric subspecialty supply are well documented, little is known about the impact of these inequalities on subspecialty utilization and child health. Children living in states with fewer pediatric subspecialists are more likely have more parent-reported unmet need for subspecialty care, 5 and decreased subspecialty access has also been associated with fewer discretionary subspecialty referrals. 9 Although these studies suggest that parent-and physician-perceived need for outpatient referral may be influenced by subspecialty supply, previous work has not evaluated the influence of local subspecialty supply on actual subspecialty utilization or child and family disease burden (such as missed school days or family financial burden).…”

“…5,[22][23][24][25][26][27] We controlled for 13 medical conditions or groups of conditions. Down syndrome, developmental delay, muscular dystrophy, and intellectual disability were grouped as "developmental diagnoses."…”

A New Model of Well-Child Care: Implications for Resource Costs and Dissemination

“…This is particularly true for children identified as high risk. 26 The design of systems such as HPWCC that allow for the allocation of appropriate resources to high-risk children through the use of new technologies to accrue efficiencies in the care of normal children will be particularly important in preventing future adverse outcomes in the high-risk group of children. We feel that the ability to model resource allocation before the implementation of such services will help organizations manage the risk associated with new innovations and will facilitate implementation and evaluation of new models of care.…”