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Xie Y, Wu J, Li Y, Liu H, Peng Y, Zhou P, Sun Y, Kang L, Jiang C, Wu H. Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review. Interact J Med Res 2024; 13:e50047. [PMID: 39110502 PMCID: PMC11339577 DOI: 10.2196/50047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 02/08/2024] [Accepted: 05/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. OBJECTIVE This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. METHODS A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. RESULTS The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. CONCLUSIONS Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.
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Affiliation(s)
- Yijun Xie
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Jing Wu
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hui Liu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yanyan Peng
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Ping Zhou
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Yizhou Sun
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Luyan Kang
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Chenghua Jiang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Graaf G, Kitchens K, Sweeney M, Thomas KC. Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:172. [PMID: 38397663 PMCID: PMC10887955 DOI: 10.3390/ijerph21020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Katherine Kitchens
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Millie Sweeney
- Family-Run Executive Director Leadership Association (FREDLA), Elliot City, MD 21042, USA
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA
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Validova A, Strane D, Matone M, Wang X, Rosenquist R, Luan X, Rubin D. Underinsurance Among Children With Special Health Care Needs in the United States. JAMA Netw Open 2023; 6:e2348890. [PMID: 38147335 PMCID: PMC10751585 DOI: 10.1001/jamanetworkopen.2023.48890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/30/2023] [Indexed: 12/27/2023] Open
Abstract
Importance A rise in pediatric underinsurance during the last decade among households with children with special health care needs (CSHCN) requires a better understanding of which households, by health care burden or income level, have been most impacted. Objective To examine the prevalence of underinsurance across categories of child medical complexity and the variation in underinsurance within these categories across different levels of household income. Design, Setting, and Participants This cross-sectional study used data from the National Survey of Children's Health and included 218 621 US children from 2016 to 2021. All children included did not reside in any type of institution (eg, correctional institutions, juvenile facilities, orphanages, long-term care facilities). Data were analyzed from January 2016 to December 2021. Exposures The primary exposure is a categorization of child health care needs constructed using parent-reported child physical and behavioral health conditions, as well as the presence of functional limitations. Main Outcomes and Measures The primary outcome variable is underinsurance, defined as absence of consistent or adequate health insurance. Models were adjusted for demographic and socioeconomic characteristics and stratified by household income. Multivariate logistic regression analysis of pooled cross-sectional survey data across multiple years (2016 to 2021) adjusted for complex survey design (weights). Results In a total sample of 218 621 children who were not in institutions and were aged 0 to 17 years from 2016 to 2021 (105 478 [48.9%] female; 113 143 [51.1%] male; 13 571 [13.0%] non-Hispanic Black children; 149 706 [51.2%] non-Hispanic White children), underinsurance prevalence was higher among the children who had complex physical conditions (3316 [37.0%]), mental or behavioral conditions (5432 [38.1%]), or complex physical conditions and functional limitations (1407 [40.7%]) or mental or behavioral conditions with limitations (3442 [41.1%]), compared with healthy children (ie, children without special health care needs or limitations) (52 429 [31.2%]). The association between underinsurance and complexity of child health care needs varied by household income. In households earning 200% to 399% federal poverty level (FPL), underinsurance was associated with children having complex physical conditions and limitations (OR, 2.74; 95% CI, 2.13-3.51) and mental or behavioral conditions and limitations (OR, 2.21; 95% CI, 1.87-2.62), compared with healthy children. In households earning 400% or more above FPL, children's mental or behavioral conditions and limitations were associated with underinsurance (OR, 3.31; 95% CI, 2.82-3.88) compared with healthy children. Conclusions and relevance In this cross-sectional study, the odds of being underinsured were not uniform among CSHCN. Both medical complexity and daily functional limitations led to increased odds of being underinsured. The concentration of underinsurance among middle-income households underpinned the challenge of health care financing for families of CSHCN whose incomes surpassed eligibility thresholds for dependent Medicaid insurance.
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Affiliation(s)
- Asiya Validova
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Douglas Strane
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics at University of Pennsylvania, Philadelphia
| | - Meredith Matone
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at University of Pennsylvania, Philadelphia
| | - Xi Wang
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics at University of Pennsylvania, Philadelphia
| | - Rebecka Rosenquist
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xianqun Luan
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David Rubin
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics at University of Pennsylvania, Philadelphia
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Kusma JD, Davis MM, Foster C. Characteristics of Medicaid Policies for Children With Medical Complexity by State: A Qualitative Study. JAMA Netw Open 2022; 5:e2239270. [PMID: 36315145 PMCID: PMC9623434 DOI: 10.1001/jamanetworkopen.2022.39270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/08/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Families of children with medical complexity (CMC) report barriers to accessing affordable coverage for the full range of services their children may need to optimize their health outcomes. Medicaid enrollment through medical need-based eligibility mechanisms can help cover these service gaps. Understanding state-by-state variation in how CMC access Medicaid may allow policy makers and pediatricians to help families navigate needed services for CMC. Objective To clarify how eligibility and coverage for CMC differ for Medicaid beneficiaries across states with different policies and managed care penetration. Design, Setting, and Participants This qualitative study used semistructured interviews with state Medicaid representatives from 23 states and Washington, DC, from February 1, 2020, to March 1, 2021. Enrollment pathways and coverage processes were discussed. Interviews were transcribed and content analysis was performed. Participants included Medicaid directors, a designee, or a state-identified policy leader with expertise in and/or responsibility for child-focused programs. Exposures State variation in Medicaid eligibility and delivery policies. Main Outcomes and Measures Eligibility pathways and coverage mechanisms for CMC in each state. Results A total of 43 informants from 23 states and Washington, DC, participated, which permitted data collection regarding almost half of the US. Four distinct eligibility pathways were characterized, with 3 specific to CMC, and the pathways that include the presence of waiting lists were distinguished. In addition, 3 coverage types at the state level were identified, consisting of fee-for-service, Medicaid managed care, or both. Two main connections between pathways and coverage mechanisms for CMC were described. Conclusions and Relevance The findings of this qualitative study suggest that state patterns in Medicaid eligibility and coverage for CMC have implications for access, including some states with substantial waiting periods for these families. Future work is needed to understand the implications of these differential Medicaid medical need-based eligibility pathways and subsequent coverage mechanisms on use of health care resources and expenditures, as well as considerations regarding challenges families of CMC face due to state-by-state variation.
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Affiliation(s)
- Jennifer D. Kusma
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Matthew M. Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Yu J, Perrin JM, Hagerman T, Houtrow AJ. Underinsurance Among Children in the United States. Pediatrics 2022; 149:183780. [PMID: 34866156 PMCID: PMC9647940 DOI: 10.1542/peds.2021-050353] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES We describe the change in the percentage of children lacking continuous and adequate health insurance (underinsurance) from 2016 to 2019. We also examine the relationships between child health complexity and insurance type with underinsurance. METHODS Secondary analysis of US children in the National Survey of Children's Health combined 2016-2019 dataset who had continuous and adequate health insurance. We calculated differences in point estimates, with 95% confidence intervals (CIs), to describe changes in our outcomes over the study period. We used multivariable logistic regression adjusted for sociodemographic characteristics and examined relationships between child health complexity and insurance type with underinsurance. RESULTS From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0% (+3.4%; 95% CI, +1.9% to +4.9%), an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9% [+3.1%; 95% CI, +1.7% to +4.5%]), which was mainly experienced as unreasonable out-of-pocket medical expenses. Although the estimate of children lacking continuous insurance coverage rose from 8.1% to 8.7% (+0.6%), it was not significant at the 95% CI (-0.5% to +1.7%). We observed significant growth in underinsurance among White and multiracial children, children living in households with income ≥200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance (adjusted odds ratio, 1.9 and 3.5, respectively). CONCLUSIONS Underinsurance is increasing among US children because of rising inadequacy. Reforms to the child health insurance system are necessary to curb this problem.
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Affiliation(s)
- Justin Yu
- Departments of Pediatrics,Address correspondence to Justin Yu, MD, MS, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Faculty Pavilion, Suite 3110, 4401 Penn Ave, Pittsburgh, PA, 15224. E-mail:
| | - James M. Perrin
- Department of Pediatrics, Harvard Medical School and MassGeneral Hospital for Children, Boston, Massachusetts
| | - Thomas Hagerman
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
| | - Amy J. Houtrow
- Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Lindly O, Eaves MC, Xu Y, Tarazi CL, Rao SR, Kuhlthau KA. Therapy use for U.S. school-aged children with developmental disabilities: State variation and determinants. Disabil Health J 2022; 15:101198. [PMID: 34489204 PMCID: PMC8812207 DOI: 10.1016/j.dhjo.2021.101198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Therapy services can support developmental needs, improve social emotional outcomes, and reduce persistent health inequities for children with developmental disabilities (DD). Receipt of therapy services may be especially timely when children with DD are school-aged, once diagnosis has often occurred. Yet limited knowledge exists on geographic variability and determinants of therapy use among school-aged U.S. children with DD. OBJECTIVES We aimed to (1) determine if therapy use varies significantly by state and (2) examine associations of health determinants with therapy use among U.S. school-aged children with DD. METHODS This was a secondary analysis of 2016 and 2017 National Survey of Children's Health data. The sample included 9984 children with DD ages 6-17 years. We obtained odds ratios and predicted margins with 95% confidence intervals from multilevel logistic regression models to examine therapy use variation and determinants. RESULTS Overall, 34.6% of children used therapy services. Therapy use varied significantly across states (σ2 = 0.11, SE = 0.04). Younger age, public insurance, functional limitations, individualized education program, frustration accessing services, and care coordination need were associated with higher adjusted odds of therapy access. In states with Medicaid Home and Community-Based Services waivers, higher estimated annual waiver cost was associated with lower adjusted odds of therapy use. CONCLUSIONS Results highlight geographic disparities in therapy use and multilevel targets to increase therapy use for school-aged children with DD.
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Affiliation(s)
- Olivia Lindly
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver Street Room 488, Flagstaff, AZ, 86011, United States.
| | - Megan C Eaves
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, United States.
| | - Yue Xu
- Department of Disabilities and Human Development, University of Illinois at Chicago, 1640 Roosevelt Road, Chicago, IL, 60608, United States.
| | - Chelsey L Tarazi
- Combined Counseling/School Psychology Program, Northern Arizona University, 801 Knoles Drive, Flagstaff, AZ, 86011, United States.
| | - Sowmya R Rao
- Massachusetts General Hospital Biostatistics Center, 50 Staniford Street, Boston, MA, 02114, United States; Department of Global Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States.
| | - Karen A Kuhlthau
- Division of Pediatric Health Outcomes Research, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States.
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7
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Lindly OJ, Crossman MK, Shui AM, Kuo DZ, Earl KM, Kleven AR, Perrin JM, Kuhlthau KA. Healthcare access and adverse family impact among U.S. children ages 0-5 years by prematurity status. BMC Pediatr 2020; 20:168. [PMID: 32303218 PMCID: PMC7164160 DOI: 10.1186/s12887-020-02058-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many children and their families are affected by premature birth. Yet, little is known about their healthcare access and adverse family impact during early childhood. This study aimed to (1) examine differences in healthcare access and adverse family impact among young children by prematurity status and (2) determine associations of healthcare access with adverse family impact among young children born prematurely. METHODS This was a secondary analysis of cross-sectional 2016 and 2017 National Survey of Children's Health data. The sample included 19,482 U.S. children ages 0-5 years including 242 very low birthweight (VLBW) and 2205 low birthweight and/or preterm (LBW/PTB) children. Prematurity status was defined by VLBW (i.e., < 1500 g at birth) and LBW/PTB (i.e., 1500-2499 g at birth and/or born at < 37 weeks with or without LBW). Healthcare access measures were adequate health insurance, access to medical home, and developmental screening receipt. Adverse family impact measures were ≥ $1000 in annual out-of-pocket medical costs, having a parent cut-back or stop work, parental aggravation, maternal health not excellent, and paternal health not excellent. The relative risk of each healthcare access and adverse family impact measure was computed by prematurity status. Propensity weighted models were fit to estimate the average treatment effect of each healthcare access measure on each adverse family impact measure among children born prematurely (i.e., VLBW or LBW/PTB). RESULTS Bivariate analysis results showed that VLBW and/or LBW/PTB children generally fared worse than other children in terms of medical home, having a parent cut-back or stop working, parental aggravation, and paternal health. Multivariable analysis results only showed, however, that VLBW children had a significantly higher risk than other children of having a parent cut-back or stop work. Adequate health insurance and medical home were each associated with reduced adjusted relative risk of ≥$1000 in annual out-of-pocket costs, having a parent cut-back or stop work, and parental aggravation among children born prematurely. CONCLUSIONS This study's findings demonstrate better healthcare access is associated with reduced adverse family impact among U.S. children ages 0-5 years born prematurely. Population health initiatives should target children born prematurely and their families.
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Affiliation(s)
- Olivia J Lindly
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver Street, Room 488, Flagstaff, AZ, 86011, USA.
| | | | - Amy M Shui
- Massachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, New York, USA
| | - Kristen M Earl
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Amber R Kleven
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - James M Perrin
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Karen A Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Cheng WY, Chang R, Novy P, O’Connor C, Duh MS, Hogea CS. Determinants of Meningococcal ACWY vaccination in adolescents in the US: completion and compliance with the CDC recommendations. Hum Vaccin Immunother 2019; 16:176-188. [PMID: 31419168 PMCID: PMC7012109 DOI: 10.1080/21645515.2019.1632679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/24/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022] Open
Abstract
Since 2011, the Advisory Committee on Immunization Practices (ACIP) guidelines for routine MenACWY vaccination in the US include a primary dose before age 16 y, preferably at ages 11-12 y, with a booster dose at age 16 y. Data on rates and drivers of meningococcal vaccination completion (receipt of both doses) and compliance with recommendations (receipt of primary dose at ages 11-12 y followed by booster at 16 y) down to state-level are limited.This study evaluated rates and determinants of MenACWY vaccination completion and compliance in adolescents aged 17 y based on data from the annual National Immunization Survey-Teen between 2011 and 2016. Individual- and state-level determinants of completion and compliance were assessed using uni-level and multi-level multivariable regression models. Average national rates were 23.2% and 12.1% for completion and compliance, respectively, with large inter-state variation observed (completion: 8.7-39.7%; compliance: 3.1-26.2%). Beyond the state of residence, factors significantly associated with a higher likelihood of both completion and compliance included being male, up-to-date on other routine vaccines, having private or hospital-based vaccine providers (vs. public) and having >1 child in the household. Factors specifically associated with completion included having >1 annual health-care visit and presence of a booster-dose vaccine mandate, while a history of asthma and high-risk health conditions had a positive association with compliance. State-level determinants of completion and compliance included pediatricians-to-children ratio and the proportion of Immunization Information System use among adolescents, respectively. Outcomes of this study may help guide clinical, policy and educational interventions to further increase MenACWY completion rates and reduce disparities in vaccination.
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Gilchrist-Scott DH, Feinstein JA, Agrawal R. Medicaid Managed Care Structures and Care Coordination. Pediatrics 2017; 140:peds.2016-3820. [PMID: 28838950 DOI: 10.1542/peds.2016-3820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. METHODS Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. RESULTS In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P < .001). Fee-for-service served as the referent. CONCLUSIONS State utilization of MMC varied widely. These data suggest that care coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs.
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Affiliation(s)
- Douglas H Gilchrist-Scott
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Rishi Agrawal
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23:e1-e9. [DOI: 10.1097/phh.0000000000000403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Zajicek-Farber ML, Lotrecchiano GR, Long TM, Farber JM. Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities. Matern Child Health J 2016; 19:1744-55. [PMID: 25724538 DOI: 10.1007/s10995-015-1688-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.
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Affiliation(s)
- Michaela L Zajicek-Farber
- National Catholic School of Social Service (NCSSS), The Catholic University of America (CUA), Shahan Hall #112, 620 Michigan Ave., NE, Washington, DC, 20064, USA,
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Fisher-Owens SA, Soobader MJ, Gansky SA, Isong IA, Weintraub JA, Platt LJ, Newacheck PW. Geography matters: state-level variation in children's oral health care access and oral health status. Public Health 2016; 134:54-63. [PMID: 26995567 DOI: 10.1016/j.puhe.2015.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. STUDY DESIGN Observational study using cross-sectional surveys. METHODS Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. RESULTS Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. CONCLUSION Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.
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Affiliation(s)
- S A Fisher-Owens
- University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
| | | | - S A Gansky
- Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA; Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA
| | - I A Isong
- MGH Center for Child and Adolescent Health Policy, Boston, MA, USA
| | - J A Weintraub
- Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA
| | - L J Platt
- Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, San Francisco, CA, USA
| | - P W Newacheck
- University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
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Eneriz-Wiemer M, Sanders LM, Barr DA, Mendoza FS. Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review. Acad Pediatr 2014; 14:128-36. [PMID: 24602575 DOI: 10.1016/j.acap.2013.10.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/29/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND One in 10 US adults of childbearing age has limited English proficiency (LEP). Parental LEP is associated with worse health outcomes among healthy children. The relationship of parental LEP to health outcomes for children with special health care needs (CSHCN) has not been systematically reviewed. OBJECTIVE To conduct a systematic review of peer-reviewed literature examining relationships between parental LEP and health outcomes for CSHCN. DATA SOURCES PubMed, Scopus, Cochrane Library, Social Science Abstracts, bibliographies of included studies. Key search term categories: language, child, special health care needs, and health outcomes. ELIGIBILITY CRITERIA US studies published between 1964 and 2012 were included if: 1) subjects were CSHCN; 2) studies included some measure of parental LEP; 3) at least 1 outcome measure of child health status, access, utilization, costs, or quality; and 4) primary or secondary data analysis. METHODS Three trained reviewers independently screened studies and extracted data. Two separate reviewers appraised studies for methodological rigor and quality. RESULTS From 2765 titles and abstracts, 31 studies met eligibility criteria. Five studies assessed child health status, 12 assessed access, 8 assessed utilization, 2 assessed costs, and 14 assessed quality. Nearly all (29 of 31) studies used only parent- or child-reported outcome measures, rather than objective measures. LEP parents were substantially more likely than English-proficient parents to report that their CSHCN were uninsured and had no usual source of care or medical home. LEP parents were also less likely to report family-centered care and satisfaction with care. Disparities persisted for children with LEP parents after adjustment for ethnicity and socioeconomic status. CONCLUSIONS AND IMPLICATIONS Parental LEP is independently associated with worse health care access and quality for CSHCN. Health care providers should recognize LEP as an independent risk factor for poor health outcomes among CSHCN. Emerging models of chronic disease care should integrate and evaluate interventions that target access and quality disparities for LEP families.
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Affiliation(s)
- Monica Eneriz-Wiemer
- Division of General Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif.
| | - Lee M Sanders
- Division of General Pediatrics, Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, Calif
| | - Donald A Barr
- Division of General Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Fernando S Mendoza
- Division of General Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif
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Eberly LE, Hodges JS, Savik K, Gurvich O, Bliss DZ, Mueller C. Extending the Peters-Belson approach for assessing disparities to right censored time-to-event outcomes. Stat Med 2013; 32:4006-20. [PMID: 23703882 DOI: 10.1002/sim.5835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/02/2013] [Indexed: 11/09/2022]
Abstract
The Peters-Belson (PB) method was developed for quantifying and testing disparities between groups in an outcome by using linear regression to compute group-specific observed and expected outcomes. It has since been extended to generalized linear models for binary and other outcomes and to analyses with probability-based sample weighting. In this work, we extend the PB approach to right-censored survival analysis, including stratification if needed. The extension uses the theory and methods of expected survival on the basis of Cox regression in a reference population. Within the PB framework, among the groups to be compared, one group is chosen as the reference group, and outcomes in that group are modeled as a function of available predictors. By using this fitted model's estimated parameters, and the predictor values for a comparator group, the comparator group's expected outcomes are then calculated and compared, formally with testing and informally with graphics, with their observed outcomes. We derive the extension, show how we applied it in a study of incontinence in nursing home elderly, and discuss issues in implementing it. We used the 'survival' package in the R system to do computations.
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Affiliation(s)
- Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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15
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Fulda KG, Johnson KL, Hahn K, Lykens K. Do unmet needs differ geographically for children with special health care needs? Matern Child Health J 2013; 17:505-11. [PMID: 22535217 DOI: 10.1007/s10995-012-1029-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.
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Affiliation(s)
- Kimberly G Fulda
- Primary Care Research Center/Texas Prevention Institute, University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
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16
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Underinsurance in Children with Special Health Care Needs: The Impact of Definition on Findings. Matern Child Health J 2012; 17:1478-87. [DOI: 10.1007/s10995-012-1155-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lutenbacher M, Karp SM, Dietrich MS, Sullivan JN. Are services to tennessee children with special health care needs comparable with national achievement of MCHB objectives? Public Health Nurs 2012; 30:7-17. [PMID: 23294383 DOI: 10.1111/phn.12000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We assessed experiences of families with children with special health care needs already engaged with Tennessee Children's Special Services or a family advocacy agency, family voices, and compared their experiences with national data to determine achievement of national maternal-child health objectives. DESIGN AND SAMPLE Using a descriptive/comparison design, Tennessee families engaged with the state or advocacy agency (n = 816) were compared with the 2005-2006 sample of the National Survey of Children with Special Health Care Needs (n = 40,840) and the Tennessee subsample (n = 794). MEASURES Primary data were obtained from a survey of families associated with either Tennessee agency. Secondary data analysis used raw data from the national survey. RESULTS All families reported challenges related to time, finances, and family interactions. Most were satisfied with health care services received. Dental care was an issue for all families, but more so for the agencies' sample. Those families also reported more problems with continuous screenings of their affected child and less coordination of care than the national sample. CONCLUSIONS Examining the experiences of families with special needs children who receive services from state agencies in the national context contributes to improving family-centered services and achieving Maternal-Child Health Bureau objectives.
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Affiliation(s)
- Melanie Lutenbacher
- Schools of Nursing and Medicine (Pediatrics), Vanderbilt University, Nashville, Tennessee 37240, USA.
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Unmet need, cost burden, and communication problems in SCHIP by special health care needs status. Matern Child Health J 2012; 16:850-9. [PMID: 21516298 DOI: 10.1007/s10995-011-0805-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Bachman SS, Comeau M, Tobias C, Allen D, Epstein S, Jantz K, Honberg L. State health care financing strategies for children with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 50:181-189. [PMID: 22731967 DOI: 10.1352/1934-9556-50.3.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We provide the first descriptive summary of selected programs developed to help expand the scope of coverage, mitigate family financial hardship, and provide health and support services that children with intellectual and developmental disabilities need to maximize their functional status and quality of life. State financing initiatives were identified through interviews with family advocacy, Title V, and Medicaid organizational representatives. Results showed that states use myriad strategies to pay for care and maximize supports, including benefits counseling, consumer- and family-directed care, flexible funding, mandated benefits, Medicaid buy-in programs, and Tax Equity and Fiscal Responsibility Act of 1982 funding. Although health reform may reduce variation among states, its impact on families of children with intellectual and developmental disabilities is not yet clear. As health reform is implemented, state strategies to ameliorate financial hardship among families of children with intellectual and developmental disabilities show promise for immediate use. However, further analysis and evaluation are required to understand their impact on family and child well-being.
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Affiliation(s)
- Sara S Bachman
- School of Social Work, Boston University, Boston, MA 02215, USA.
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Iida H, Lewis CW. Utility of a Summative Scale Based on the Children with Special Health Care Needs (CSHCN) Screener to Identify CSHCN with Special Dental Care Needs. Matern Child Health J 2011; 16:1164-72. [DOI: 10.1007/s10995-011-0894-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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21
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Murphy NA, Carbone PS. Parent-provider-community partnerships: optimizing outcomes for children with disabilities. Pediatrics 2011; 128:795-802. [PMID: 21949138 DOI: 10.1542/peds.2011-1467] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children with disabilities and their families have multifaceted medical, developmental, educational, and habilitative needs that are best addressed through strong partnerships among parents, providers, and communities. However, traditional health care systems are designed to address acute rather than chronic conditions. Children with disabilities require high-quality medical homes that provide care coordination and transitional care, and their families require social and financial supports. Integrated community systems of care that promote participation of all children are needed. The purpose of this clinical report is to explore the challenges of developing effective community-based systems of care and to offer suggestions to pediatricians and policy-makers regarding the development of partnerships among children with disabilities, their families, and health care and other providers to maximize health and well-being of these children and their families.
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Kogan MD, Newacheck PW, Blumberg SJ, Ghandour RM, Singh GK, Strickland BB, van Dyck PC. Underinsurance among children in the United States. N Engl J Med 2010; 363:841-51. [PMID: 20818845 DOI: 10.1056/nejmsa0909994] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent interest in policy regarding children's health insurance has focused on expanding coverage. Less attention has been devoted to the question of whether insurance sufficiently meets children's needs. METHODS We estimated underinsurance among U.S. children on the basis of data from the 2007 National Survey of Children's Health (sample size, 91,642 children) regarding parents' or guardians' judgments of whether their children's insurance covered needed services and providers and reasonably covered costs. Data on adequacy were combined with data on continuity of insurance coverage to classify children as never insured during the past year, sometimes insured during the past year, continuously insured but inadequately covered (i.e., underinsured), and continuously insured and adequately covered. We examined the association between this classification and five overall indicators of health care access and quality: delayed or forgone care, difficulty obtaining needed care from a specialist, no preventive care, no developmental screening at a preventive visit, and care not meeting the criteria of a medical home. RESULTS We estimated that in 2007, 11 million children were without health insurance for all or part of the year, and 22.7% of children with continuous insurance coverage--14.1 million children--were underinsured. Older children, Hispanic children, children in fair or poor health, and children with special health care needs were more likely to be underinsured. As compared with children who were continuously and adequately insured, uninsured and underinsured children were more likely to have problems with health care access and quality. CONCLUSIONS The number of underinsured children exceeded the number of children without insurance for all or part of the year studied. Access to health care and the quality of health care are suboptimal for uninsured and underinsured children. (Funded by the Health Resources and Services Administration.)
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Affiliation(s)
- Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, Rockville, MD 20857, USA.
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Affiliation(s)
- Matthew M Davis
- Child Health Evaluation and Research Unit, and the Gerald R. Ford School of Public Policy, University of Michigan, 300 N Ingalls, Room 6C23, Ann Arbor, MI 48109-5456, USA.
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