Maternal and Child Health Journal

, Volume 17, Issue 8, pp 1478–1487 | Cite as

Underinsurance in Children with Special Health Care Needs: The Impact of Definition on Findings

  • Julie K. Preskitt
  • Rene P. McEldowney
  • Beverly A. Mulvihill
  • Martha S. Wingate
  • Nir Menachemi
Article

Abstract

To identify differences in groups of children with special healthcare needs (CSHCN) identified as underinsured by two alternate definitions and discuss implications for policy decisions based on using one definition over another. Secondary data from the National Survey of CSHCN 2005/2006 were analyzed. Only CSHCN who were continuously-insured for 12 months were included in analyses. We identified groups of underinsured CSHCN using two general definitions (“economic” and “attitudinal”) and three mutually-exclusive groups (identified by both definitions, identified by attitudinal but not economic, and identified by economic but not attitudinal). Key variables included demographics and condition characteristics. Different underinsurance rates were identified [attitudinal = 30.9 % (n = 11,470); economic = 22.7 % (n = 8,447)] with fair agreement by kappa score (κ = 0.3194; Z = 65.91; p > 0.0001). Differences across mutually-exclusive groups included family income ≥400 % FPL (attitudinal only = 34.2 %, economic only = 16.3 %, both = 18.4 %; p < 0.001) and high severity (attitudinal only = 42.5 %, economic only = 68.5 %, both = 69.9 %; p < 0.001). CSHCN who needed equipment/supplies/home health (OR = 1.31, p < 0.001) had increased odds of being identified as underinsured by the economic, but not attitudinal definition. CSHCN with private insurance had increased odds of being identified by attitudinal only or both definitions, but not by economic only (AO: OR = 1.41, p < 0.001; BOTH: OR = 2.36, p < 0.001). Despite overlap between the two definitions, choosing either one excludes some CSHCN, potentially underestimating the extent of underinsurance and masking important findings related to specific conditions characteristics. A definition that comprehensively identifies and describes underinsurance is vital to translating health insurance coverage expansion into benefit packages that meet complex health and service needs.

Keywords

Children with special healthcare needs Underinsurance 

References

  1. 1.
    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), 117–123.PubMedCrossRefGoogle Scholar
  2. 2.
    National Survey of Children with Special Health Care Needs (2005/2006). Centers for disease control and prevention. National Center for Health Statistics. Child and Adolescents Health Measurement Initiative. Data Resource Center for Child and Adolescent HealthGoogle Scholar
  3. 3.
    Houtrow, A., Kim, S., & Newacheck, P. (2008). Health care utilization, access, and expenditures for infants and young children with special health care needs. Infants and Young Children, 21(2), 149–159.CrossRefGoogle Scholar
  4. 4.
    Kuhlthau, K., Hill, K., Yucel, R., & Perrin, J. (2005). Financial burden for families of children with special health care needs. Maternal and Child Health Journal, 9(2), 207–218.PubMedCrossRefGoogle Scholar
  5. 5.
    Newacheck, P., & Kim, S. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159, 10–17.PubMedCrossRefGoogle Scholar
  6. 6.
    Newcheck, P., Inkelas, M., & Kim, S. (2004). Health services use and health care expenditures for children with disabilities. Pediatrics, 114(1), 79–85.CrossRefGoogle Scholar
  7. 7.
    Tu, H., & Cunningham, P. (2005). Public coverage provides vital safety net for children with special health care needs. pp. 1–7. Cent Stud Health Syst Change.Google Scholar
  8. 8.
    Davidoff, A. (2004). Insurance for children with special health care needs: patterns of coverage and burden on families to provide adequate coverage. Pediatrics, 114(2), 394–403.PubMedCrossRefGoogle Scholar
  9. 9.
    Kogan, M., Newacheck, P., Honberg, L., & Strickland, B. (2005). Association between underinsurance and access to care among children with special health care needs in the united states. Pediatrics, 116(5), 1162–1169.PubMedCrossRefGoogle Scholar
  10. 10.
    Jeffrey, A., & Newacheck, P. (2006). Role of insurance for children with special health care needs: a synthesis of the evidence. Pediatrics, 118, e1027–e1038.PubMedCrossRefGoogle Scholar
  11. 11.
    Newacheck, P., Houtrow, A., Romm, D., Kuhlthau, K., Bloom, S., Van Cleave, J., et al. (2009). The future of health insurance for children with special health care needs. Pediatrics, 123, e940–e947.PubMedCrossRefGoogle Scholar
  12. 12.
    Honberg, L., McPherson, M., Strickland, B., Gage, J., & Newacheck, P. (2005). Assuring adequate health insurance results of the national survey of children with special health care needs. Pediatrics, 115(5), 1233–1239.PubMedCrossRefGoogle Scholar
  13. 13.
    Kogan, M., & van Dyck, P. (2005). The national survey of children with special health care needs: using state-level data to improve systems of care for children with special health care needs. Pediatrics, 115(9), S1–S2.Google Scholar
  14. 14.
    Kogan, M., Newacheck, P., Blumberg, S., Ghandour, R., Singh, G., Strickland, B., et al. (2010). Underinsurance among children in the United States. The New England Journal of Medicine, 363(9), 841–851.PubMedCrossRefGoogle Scholar
  15. 15.
    Honberg, L., Kogan, M., Allen, D., Strickland, B., & Newacheck, P. (2009). Progress in ensuring aequate health insurance for children with special health care needs. Pediatrics, 124, 1273–1280.PubMedCrossRefGoogle Scholar
  16. 16.
    Kogan, M., Newacheck, P., Blumberg, S., Heyman, K., Strickland, B., Singh, G., et al. (2010). State variation in underinsurance among children with special health care needs in the United States. Pediatrics, 125, 673–680.PubMedCrossRefGoogle Scholar
  17. 17.
    Oswald, D., Bodurtha, J., Broadus, C., Willis, J., Tlusty, S., Bellin, M., et al. (2005). Defining underinsurance among children with special health care needs: a Virginia sample. Maternal and Child Health Journal, 9(2 Suppl), S67–S74.PubMedCrossRefGoogle Scholar
  18. 18.
    Oswald, D., Bodurtha, J., Willis, J., & Moore, M. (2007). Underinsurance and key health outcomes for children with special health care needs. Pediatrics, 119(2), e341–e347.PubMedCrossRefGoogle Scholar
  19. 19.
    Ward, A. (2006). The concept of underinsurance: a general typology. Journal of Medicine and Philosophy, 31, 499–531.PubMedCrossRefGoogle Scholar
  20. 20.
    “Maternal and child health services title V block grant program: guidance and forms for the title V application/annual report—5th ed.” U.S. Department of Health and Human Services. Division of State and Community Health. Maternal and Child Health Bureau. Bethesda, MD: OMB NO: 0915-0172 EXPIRES: March 31, 2012.Google Scholar
  21. 21.
    Blumberg, S., Welch E. M., Chowdhury S., Upchruch H., Parker E., Skalland B. (2008). Design and operation of the National Survey of Children with Special Health Care Needs, 2005–2006. Vital and Health Statistics, 1(45).Google Scholar
  22. 22.
    Bethell, C., Read, D., Stein, R., Blumberg, S., Wells, N., & Newcheck, P. (2002). Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2, 38–47.PubMedCrossRefGoogle Scholar
  23. 23.
    Mulvihill, B., Wingate, M., Altarac, M., Redden, D., Mulvihill, F., Telfair, J., et al. (2005). The association of child condition severity with family functioning and relationship with health care providers among children and youth with special health care needs in alabama. Maternal and Child Health Journal, 9(2 Suppl), S87–S97.PubMedCrossRefGoogle Scholar
  24. 24.
    Landis, J., & Koch, G. (1977). The measurement of observer agreement for categorical data. Personnel Psychology 28:563–575. In A. Acock (ed.). A gentle introduction to stata, 3rd, pp. 330. College Station, TX: Stata Press, StataCorp LP; 2010.Google Scholar
  25. 25.
    Bethell, C., Kogan, M., Strickland, B., Schor, E., Robertson, J., & Newacheck, P. (2011). A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations. Academic Pediatrics, 11, S22–S33.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Julie K. Preskitt
    • 1
  • Rene P. McEldowney
    • 2
  • Beverly A. Mulvihill
    • 1
  • Martha S. Wingate
    • 1
  • Nir Menachemi
    • 1
  1. 1.Health Care Organization and PolicyUniversity of Alabama at Birmingham School of Public HealthBirminghamUSA
  2. 2.Health AdministrationAuburn UniversityAuburnUSA

Personalised recommendations