The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #57221

Victoria A. Freeman, RN, DrPH¹, Rebecca Slifkin, PhD¹, Robert Schwartz, MA¹, and Anita M. Farel, DrPH². (1) Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Rd, CB #7590, Chapel Hill, NC 27599-7590, 919-966-6168, victoria_freeman@unc.edu, (2) Maternal and Child Health, School of Public Health, 426 Rosenau Hall, CB# 7445, University of North Carolina, Chapel Hill, NC 27599-7545

The health care experience of children with special health care needs (CSHCN) enrolled in North Carolina’s SCHIP (NCHC) is compared to that of similar children on Medicaid and State Employees’ Health Plan (SEHP) to assess the ability of the insurance plans to meet the needs of CSHCN. Sample children were identified from insurance claims with diagnosis codes indicating ongoing health problems. Fifteen hundred children were sampled from each plan, stratified across five diagnosis groups: asthma, ADD/ADHD, other chronic diseases, developmental delay and mental health. Parents were surveyed about their child by mail. Survey response was 61% (N=2,729). Reported access to most types of health care was good for all children. Significant barriers to receipt of dental care remain. Unmet need was greatest for Medicaid children (10%), with lower rates of unmet need for NCHC and SEHP children. Differences across insurance plans support a gradient of need for and access to care that ranges from more need/less access for Medicaid children to less need/more access for SEHP children, with NCHC children in between. Parents of CSHCN on NCHC reported better access to care than did parents of Medicaid children. The reasons for differences are likely complex and not attributable to insurance alone. Provider reimbursement is higher for NCHC than for Medicaid, but results cannot be explained by reimbursement rates alone. SEHP enrollees have better access despite reimbursement rates equal to those of NCHC. Family income and other barriers faced by the economically disadvantaged are other important factors in access to care.

Learning Objectives:

• Describe differences in access to care for CSHCN insured by different public and private insurance plans.
• Identify barriers to care for CSHCN

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.