173433 Multivariate analysis of state variation in underinsurance among children with special health care needs in the US, 2005-06

Tuesday, October 28, 2008: 9:00 AM

Michael D. Kogan, PhD , Office of Epidemiology, Policy and Evaluation, HRSA/ Maternal and Child Health Bureau, Rockville, MD
Paul Newacheck, DrPH , Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA
Bonnie B. Strickland, PhD , Maternal and Child Health Bureau/Division of Services for Children with Special Health Care Needs, Health Resources and Services Administration, Rockville, MD
Stephen J. Blumberg, PhD , National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
Gopal K. Singh, PhD , Office of Data and Program Development, HRSA/Maternal and Child Health Bureau, Rockville, MD
Mary Beth Zeni, ScD , College of Nursing, Florida State University, Tallahassee, FL
Lynda Honberg, MHSA , Maternal and Child Health Bureau/Division of Services for Children with Special Health Care Needs, Health Resources and Services Administration, Rockville, MD
Heather L. Free, MPH , National Center for Health Statistics, Hyattsville, MD
Kathleen M. Heyman, MS , Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD
National attention has focused on providing health insurance coverage for children. Considerably less attention has been given to underinsurance, particularly for children with special health care needs (CSHCN). While about 14% of US children have a special health care need, CSHCN account for 42% of medical costs for children. However, no study has examined state variations in underinsurance. We used the 2005-2006 National Survey of CSHCN, a nationally representative study of 40,000 CSHCN that can provide state estimates, to address state variations in underinsurance. CSHCN with health insurance were considered underinsured if a parent reported that the benefits did not usually or always meet the child's needs; or costs not covered by insurance were not usually or always reasonable; or the insurance plan did not usually or always allow the child to see needed providers. We calculated the unadjusted prevalence for underinsurance for each state. Using logistic regression, we estimated state-specific odds and prevalence for underinsurance after adjusting for poverty level, race/ethnicity, gender, family structure, language use, insurance type, and severity of child's health condition. Unadjusted underinsurance rates for states ranged from 27-47%, which, after multivariate adjustments, diminished to 24-40%. Multivariate analysis indicated that CSHCN's state of residence had a strong association with insurance adequacy. The odds of being underinsured were about 2 times greater for CSHCN in some states compared to Hawaii, which had the lowest underinsurance rate. These factors only partly explain state variations in underinsurance, indicating that the disparity may also be driven by macro-level factors.

Learning Objectives:
1. Describe what constitutes underinsurance for children with special health care needs (CSHCN). 2. Describe the issues that put CSHCN at increased risk for underinsurance at the state level. 3. Understand the macro-level factors affecting underinsurance at the state level.

Keywords: Children With Special Needs, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I've published on this topic, and I'm the study director.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.