Underinsurance in Children with Special Health Care Needs

Abstract

Children with Special Health Care Needs (CSHCN) are a small part of the total population, but use more services and account for more costs than do their healthy peers. By the very nature of who they are and the health-related challenges they face, CSHCN are vulnerable to poor outcomes associated with delayed care and often live in families that are the most likely to be negatively impacted by high cost-sharing requirements. Current literature has suggested that inadequate insurance—underinsurance — is a much larger problem than is uninsurance. This supports the idea that researchers and policymakers should move beyond simple discussions of presence or absence of insurance coverage, but should pursue more in-depth analyses of the adequacy of insurance. This is critical to assuring that appropriate, necessary benefits and services are provided at a reasonable and affordable cost. This project has examined what it means to be underinsured according to four separate definitions – attitudinal, economic, structural, and equipment/supplies. This research used existing data from the National Survey of Children with Special Health Care Needs, 2005/06 to examine four definitions for underinsurance using specific questions from the survey in an effort to more fully describe the insurance experiences of CSHCN and their families. Only CSHCN who were continuously insured for the entire year preceding the survey interview were included in analysis. SPSS 17.0, Complex Samples was used for univariate, bivariate, and multivariate analysis. Since all 4 definitions for the dependent variable were dichotomous, categorical responses, binary logistic regression – LOGIT – techniques were utilized. Varying percentages of CSHCN were identified as underinsured based upon which definition was considered. Also, different predictor variables had significant impact by definition, indicating that the definitions identified unique groups of children with diverse risk factors. It is important to consider a broad definition to comprehensively describe the scope of underinsurance in this population. Certain groups of CSHCN and those with specific condition characteristics may be more at risk for underinsurance based upon the definition use in analysis. Stratifications by insurance type and condition-specific subgroups revealed additional variation.