Maternal and Child Health Journal

, Volume 13, Issue 2, pp 176–186 | Cite as

The Influence of Health Insurance on Parent’s Reports of Children’s Unmet Mental Health Needs

  • LeaAnne DeRigne
  • Shirley Porterfield
  • Stacie Metz
Article

Abstract

Objective The purpose of this study was to examine the prevalence of unmet mental health needs in children identified by parents as having long-term emotional and behavioral problems, to identify the characteristics of these children, and to evaluate the influence of health insurance status and type on the odds of reporting unmet mental health needs. Methods We used the National Survey of Children with Special Health Care Needs (NSCSHCN) to estimate the prevalence of unmet mental health needs among children with long-term emotional/behavioral conditions. Using logistic regression models, we also assessed the independent impact of insurance status and type on unmet needs. Results Analyses indicated that of the nearly 67% of children who needed mental health care or counseling in the previous 12 months, 20% did not receive it. Moreover, parents of uninsured children were more likely to report unmet mental health needs than insured children. Parents of children covered by public health insurance programs (Medicaid, Children Health Insurance Program-CHIP, Title V, Military, Native American) were less likely to report unmet mental health needs than those with children covered by private health insurance plans. Conclusion Results from this study suggest a need for expansion of health insurance coverage to children especially those with long-term mental health conditions. It also suggests a need for parity between mental and physical health benefits in private health insurance.

Keywords

Mental health Special health care needs Unmet need Medicaid Children’s Health Insurance Program 

Abbreviations

CSHCN

Children with special health care needs

CHIP

Children’s Health Insurance Program

EDB

Emotional, development, or behavioral

FPL

Federal poverty level

NSCSHCN

National Survey of Children with Special Health Care Needs

References

  1. 1.
    NAMI. (1999). Families on the brink: the impact of ignoring children with serious mental illness.Google Scholar
  2. 2.
    U.S. Department of Health and Human Services, Health Resources and Service Administration, Maternal and Child Health Journal. (2004). The National Survey of Children with Special Health Care Needs Chartbook 2001 (p. 111).Google Scholar
  3. 3.
    McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1), 137–140. doi:10.1542/peds.102.1.137.PubMedCrossRefGoogle Scholar
  4. 4.
    Van Dyck P., Kogan M., McPherson M., Weissman G., Newacheck P. (2004). Prevalence and characteristics of children with special health care needs. Archives of Pediatric and Adolescent Medicine, 158, 884–890. doi:10.1001/archpedi.158.9.884.CrossRefGoogle Scholar
  5. 5.
    Briggs-Gowan, M., Horwitz, S. C., Schwab-Stone, M., Leventhal, J., & Leaf, P. J. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child and Adolescent Psychiatry, 39(7), 841–849. doi:10.1097/00004583-200007000-00012.PubMedCrossRefGoogle Scholar
  6. 6.
    USDHHS. (2000). Mental Health: A report of the Surgeon General.Google Scholar
  7. 7.
    Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S., Hoven, C., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889–899. doi:10.1097/00004583-199607000-00014.PubMedCrossRefGoogle Scholar
  8. 8.
    Shaffer, D., Fisher, P., Dulcan, M., Davies, M., Piacentini, J., Schwab-Stone, M., et al. (2000). The NIMH Diagnostic Interview Schedule for children version 2.3: Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 865–877.CrossRefGoogle Scholar
  9. 9.
    Wood, D., Hayward, R., Corey, C., Freeman, H. E., & Shapiro, M. (1990). Access to medical care for children and adolescents in the United States. Pediatrics, 86, 666–673.PubMedGoogle Scholar
  10. 10.
    Holl, J., Szilagyi, P. G., Rodewalk, L., Bryd, R., & Weitzman, M. (1995). Profile of uninsured children in the United States. Archives of Pediatric and Adolescent Medicine, 149, 398–406.Google Scholar
  11. 11.
    Currie, J., & Gruber, J. (1995). Health Insurance eligibility, utilization of medical care, and child health. Quarterly Journal of Economics, 274, 1429–1435.Google Scholar
  12. 12.
    Aday, L., Lee, E., Spears, B., Chung, C., Youssef, A., & Bloom, B. (1993). Health insurance and utilization of medical care for children with special health care needs. Medical Care, 31, 1013–1026. doi:10.1097/00005650-199311000-00004.PubMedCrossRefGoogle Scholar
  13. 13.
    Newacheck, P., Stoddard, J., Hughes, D., & Pearl, M. (1998). Health insurance and access to primary care for children. New England Journal of Medicine, 338(8), 513–519. doi:10.1056/NEJM199802193380806.PubMedCrossRefGoogle Scholar
  14. 14.
    Porterfield, S., & McBride, T. (2007). The effect of poverty and caregiver education on preceived need and access to health services among children with special health care needs. American Journal of Public Health, 97(2), 323–329. doi:10.2105/AJPH.2004.055921.PubMedCrossRefGoogle Scholar
  15. 15.
    Newacheck, P., Hughes, D., Hung, Y.-Y, Wong, S., & Stoddard, J. (2000). The unmet health needs of America’s children. Pediatrics, 105(4), 989–997. doi:10.1542/peds.105.4.760.PubMedCrossRefGoogle Scholar
  16. 16.
    Newacheck, P., McManus, M., Fox, H., Hung, Y.-Y, & Halfon, N. (2000). Access to health care for children with special health care needs. Pediatrics, 105(4), 760–766. doi:10.1542/peds.105.4.760.PubMedCrossRefGoogle Scholar
  17. 17.
    Yu, H., Dick A., & Szilagyi, P. G. (2006–2007). Role of SCHIP in serving children with special health care needs. Health Care Financing Review, 28(2), 53–64.Google Scholar
  18. 18.
    Newacheck, P., Pearl, M., Hughes, D., & Halfon, N. (1998). The role of medicaid in ensuring children’s access to care. The Journal of the American Medical Association, 280(20), 1789–1793. doi:10.1001/jama.280.20.1789.CrossRefGoogle Scholar
  19. 19.
    Ganz, M. L., Shalini, A., & Tendulkar, A. (2006). Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs. Pediatrics, 117(6), 2138–2149. doi:10.1542/peds.2005-1531.PubMedCrossRefGoogle Scholar
  20. 20.
    Feinberg, E., Swartz, A., Zaslavsky, A., Gardner, J., & Walker, D. K. (2002). Family income and the impact of a children’s health insurance program on reported need for health services and unmet health need. Pediatrics, 109(2), 29–39. doi:10.1542/peds.109.2.e29.CrossRefGoogle Scholar
  21. 21.
    Fox, M. H., Moore, J., Davis, R., & Heintzelman, R. (2003). Changes in reported health status and unmet need for children enrolling in the Kansas Children’s Health Insurance Program. American Journal of Public Health, 93(4), 579–589.PubMedCrossRefGoogle Scholar
  22. 22.
    Szilagyi, P. G., Shenkman, E., Brach, C., LaClair, B. J., Swigonski, N., Dick, A., et al. (2003). Children with special health needs enrolled in the state children’s health insurance program (SCHIP): Patient characteristics and health care needs. Pediatrics, 112(6), 508–520.Google Scholar
  23. 23.
    Lave, J. R., Keane, C. R., Lin, C. J., Ricci, E. M., Amersbach, G., & LaVallee, C. P. (1998). The Impact of lack of health insurance on children. Journal of health and Social Policy, 10(2), 57–73. doi:10.1300/J045v10n02_05.PubMedCrossRefGoogle Scholar
  24. 24.
    Kenney, G., & Yee, J. (2007). SCHIP at a crossroads: experiences to date and challenges ahead. Health Affairs, 26(2), 356–369. doi:10.1377/hlthaff.26.2.356.PubMedCrossRefGoogle Scholar
  25. 25.
    Szilagyi, P. G., Shone, L., Klein, J., Bajorska, A., & Dick, A. (2007). Improved health care among children with special health needs after enrollment into the state children’s health insurance program. Ambulatory Pediatrics, 7(1), 10–17. doi:10.1016/j.ambp.2006.09.006.PubMedCrossRefGoogle Scholar
  26. 26.
    Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555. doi:10.1176/appi.ajp.159.9.1548.PubMedCrossRefGoogle Scholar
  27. 27.
    Frank, R., Koyanagi, C., & McGuire, T. (1997). The politics and economics of mental health parity laws. Health Affairs, 16(4), 108–119. doi:10.1377/hlthaff.16.4.108.PubMedCrossRefGoogle Scholar
  28. 28.
    Burnam, M. A., & Escarce, J. (1999). Equity in managed care for mental disorders. Health Affairs, 18(5), 22–31. doi:10.1377/hlthaff.18.5.22.PubMedCrossRefGoogle Scholar
  29. 29.
    Buck, J., Teich, J., Umland, B., & Stein, M. (1999). Behavioral health benefits in employer-sponsored health plans, 1997. Health Affairs, 18(2), 67–78. doi:10.1377/hlthaff.18.2.67.PubMedCrossRefGoogle Scholar
  30. 30.
    Frank, R., & McGuire, T. (1994). Health reform and financing of mental health services: Distributional consequences. In R. Manderscheid & M. Sonnenschein (Eds.), Mental Health, United States, 1994. Washington, DC: U.S. Government Printing Office.Google Scholar
  31. 31.
    Andersen, R. (1968). Behavioral model of families’ use of health services. Chicago: University of Chicago.Google Scholar
  32. 32.
    Andersen, R., & Newman, J. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly, 51, 95–124. doi:10.2307/3349613.CrossRefGoogle Scholar
  33. 33.
    Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. doi:10.2307/2137284.PubMedCrossRefGoogle Scholar
  34. 34.
    Bethell, C. D., Read, D., Stein, R., Blumberg, S., Wells, N., & Newacheck, P. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2(1), 38–48. doi:10.1367/1539-4409(2002)002<0038:ICWSHC>2.0.CO;2.PubMedCrossRefGoogle Scholar
  35. 35.
    Blumberg, S., Olson, L., Frankel, M., Osborn, L., Becker, C., Srinath, K. P., Giambo, P. (2003). Design and operation of the National Survey of Children with Special Health Care Needs, 2001. National Center for Health Statistics. Vital Health Statistics, Series 1(41), 1–36.Google Scholar
  36. 36.
    Van Dyck, P., Kogan, M., Heppel, D., Blumberg, S., Cynamon, M., & Newacheck, P. (2004). The national survey of children’s health: A new data resource. Maternal and Child Health Journal, 8(3), 183–188. doi:10.1023/B:MACI.0000037693.09847.f6.PubMedCrossRefGoogle Scholar
  37. 37.
    Jokovic, A., Locker, D., & Guyatt, G. (2003). How well do parents know their children? Implications for proxy reporting of child health-related quality of life. Quality of Life and Research, 13, 1297–1307. doi:10.1023/B:QURE.0000037480.65972.eb.CrossRefGoogle Scholar
  38. 38.
    von Essen, L. (2004). Proxy ratings of patient quality of life. Acta Oncologica, 43(3), 229–234. doi:10.1080/02841860410029357.CrossRefGoogle Scholar
  39. 39.
    Mayer, M., Skinner, A., & Slifkin, R. (2004). Unmet need for routine and specialty care: Data from the National Survey Of Children With Special Health Care Needs. Pediatrics, 113(2), 109–115. doi:10.1542/peds.113.2.e109.CrossRefGoogle Scholar
  40. 40.
    Strickland, B., McPherson, M., Weissman, G., van Dyck, P., Huang, Z., & Newacheck, P. (2004). Access to the medical home: Results of the national survey of children with special health care needs. Pediatrics, 113(5), 1485–1492.PubMedGoogle Scholar
  41. 41.
    Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/Adolescent behavioural and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213–232. doi:10.1037/0033-2909.101.2.213.PubMedCrossRefGoogle Scholar
  42. 42.
    Blumberg, S., Osborn, L., Luke, J., Olson, L., & Frankel, M. (2004). Estimating the prevalence of uninsured children: An evaluation of data from the National Survey Of Children With Special Health Care Needs. Vital and Health Statistics, 2(136), 1–46.Google Scholar
  43. 43.
    Wells, K. B., Kataoka, S. H., & Asarnow, J. R. (2001). Affective disorders in children and adolescents: Addressing unmet need in primary care settings. Society of Biological Psychiatry, 49, 1111–1120. doi:10.1016/S0006-3223(01)01113-1.CrossRefGoogle Scholar
  44. 44.
    Mechanic, D., & McAlpine, D. (1999). Mission unfulfilled: Potholes on the road to mental health parity. Health Affairs, 18(5), 7–21. doi:10.1377/hlthaff.18.5.7.PubMedCrossRefGoogle Scholar
  45. 45.
    Sturm, R., & McCulloch, J. (1998). Mental health and substance abuse benefits in carve-out plans and the mental health parity act of 1996. Journal of Health Care Finance, 24(3), 82–92.PubMedGoogle Scholar
  46. 46.
    Bazelon. (2004). Mental health hits and misses in 108th Congress. Retrieved from http://www.bazelon.org/takeaction/archive/2004/12-04update.htm. on 11 Nov 2005.
  47. 47.
    Smith, V., Rousseau, D. (2005). SCHIP enrollment in the 50 States: Kaiser Family Foundation.Google Scholar
  48. 48.
    Haley, J., Kenney, G. (2001). Why aren’t more uninsured children enrolled in Medicaid or SCHIP? Urban Institute.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • LeaAnne DeRigne
    • 1
  • Shirley Porterfield
    • 2
  • Stacie Metz
    • 3
  1. 1.St. LouisUSA
  2. 2.School of Social WorkUniversity of Missouri-St. LouisSt. LouisUSA
  3. 3.Department of HealthWest Chester UniversityWest ChesterUSA

Personalised recommendations