Impact of Health Insurance Cost-Sharing and Benefits on Unmet Need for Children with Special Health Care Needs

Previous research suggests that children with special health care needs (CSHCN) face more access problems than other children, and their families report more problems paying medical bills. We sought to investigate the impact of health insurance cost-sharing and generosity of benefits on delayed or forgone care for CSHCN, using a nationally representative population-based sample. We examined data on 33,209 continuously insured CSHCN from the 2005-2006 National Survey of Children with Special Health Care Needs. Delayed or forgone care was defined as self-report of delayed or forgone needed health care for the reference child during the past 12 months. Reporting that the child's current health insurance does not allow them to see needed providers is the strongest predictor of delayed or forgone care (OR 2.10, 95% CI: 1.84-2.41). Reporting unreasonable non-covered medical expenses (OR 1.42, 95% CI: 1.27-1.60), needing additional income to cover medical expenses (OR 1.57, 95% CI: 1.37-1.79), experiencing financial problems (OR 1.69, 95% CI: 1.49-1.92), and insufficient benefits (OR 1.91, 95% 1.68-2.19) are also significant predictors of delayed or forgone care in a mutually adjusted analysis. The level of cost-sharing and benefit plan design are important factors in determining healthcare utilization and if perceived to be excessive or burdensome, can result in unmet need for CSHCN. This group needs comprehensive benefits and reasonable cost-sharing within private and public insurance plans to prevent unmet healthcare need.