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The Financial Implications of Availability and Quality of a Usual Source of Care for Children with Special Health Care Needs

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Abstract

Objective

To examine the relationship of availability and quality of a usual source of care (USC) to medical expenditures overall and for various types of health care services for children with special health care needs (CSHCN), as a group and by four diagnostic subgroups (asthma, non-asthmatic physical conditions, mental retardation, other mental illnesses).

Methods

Generalized linear models were used to estimate the annual average per capita medical expenditures (APCME) based on data from 820 CSHCN in the 1995 National Health Interview Survey on Disability and 1996 Medical Expenditure Panel Survey.

Results

In 1996, 92% of non-institutionalized CSHCN in the United States had a USC. Of these, 52% were classified as receiving accessible care, 95% received comprehensive care, and 69% received satisfactory care. Approximately 89% of CSHCN had expenditures on health care in 1996 and the APCME was $1,344 for CSHCN as a group. Having a USC was associated with higher expenditures overall and for almost all types of health care services for CSHCN across conditions. Receiving comprehensive care was associated with lower total medical expenditures for CSHCN with asthma, whereas receiving satisfactory care was associated with higher total medical expenditures for CSHCN with non-asthma physical conditions.

Conclusion

Having a regular care provider is associated with higher expenditures for CSHCN across diagnosis. Among CSHCN with a USC, quality of care is associated with medical expenditures, although specific associations vary by the quality characteristic and the condition of the child. These results may mask heterogeneity in severity of condition and quality of care over time.

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Authors and Affiliations

  1. Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building 6th Floor, Boston, MA, 02115, USA

    Chia-Ling Liu, Michael L. Ganz, Steven Gortmaker & Marie C. McCormick

  2. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA

    Alan M. Zaslavsky

  3. Child and Adolescent Health Policy, Massachusetts General Hospital, 50 Staniford Street, Suite 901, Boston, MA, 02114, USA

    James Perrin

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  1. Chia-Ling Liu
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  2. Alan M. Zaslavsky
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  3. Michael L. Ganz
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  4. James Perrin
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  5. Steven Gortmaker
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  6. Marie C. McCormick
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Correspondence to Chia-Ling Liu.

Appendix

Appendix

Appendix 1 Access and quality of health care items in the MEPS used in the analysesa
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Liu, CL., Zaslavsky, A.M., Ganz, M.L. et al. The Financial Implications of Availability and Quality of a Usual Source of Care for Children with Special Health Care Needs. Matern Child Health J 12, 243–259 (2008). https://doi.org/10.1007/s10995-007-0233-0

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