185558 Discontinuous coverage among U.S. children with special health care needs and emotional conditions: An analysis of the 2005/06 National Survey of Children with Special Health Care Needs for health services planning

Tuesday, October 28, 2008: 1:00 PM

Mary Beth Zeni, ScD , College of Nursing, Florida State University, Tallahassee, FL
Michael D. Kogan, PhD , Office of Epidemiology, Policy and Evaluation, HRSA/ Maternal and Child Health Bureau, Rockville, MD
     
Children with special health care needs (CSHCN), including those with emotional conditions, often require consistent, coordinated care. However, discontinuous health care coverage, defined as a period without health insurance in the previous year, can result in lack of care continuity. We used the 2005-2006 National Survey of CSHCN, a public access, population-based dataset with US and state representative sampling, to examine factors associated with discontinuous coverage, particularly for CSHCN with emotional conditions. Descriptive analyses, available at www.childhealthdata.org, note 21% of CSHCN had emotional conditions with an increased number reporting discontinuous coverage. Using the Aday and Andersen Access to Medical Care Model to group variables into predisposing, need, and enabling factors, we conducted multivariate analyses and initial models found the following groups were at increased risk for discontinuous coverage: Hispanics (odds ratio=1.34 (CI: 1.06-1.71); blacks (OR=1.22 (CI: 1.00-1.49); children with emotional problems (OR=1.22 (CI: 1.04-1.43); delayed or foregone needed care (OR= 5.96 (CI 5.01-7.08); lack of personal healthcare provider (OR=1.76 (CI: 1.39-2.23); below federal poverty level (OR=2.66 (CI: 2.02-3.51); poverty level 100-199% (OR=2.95 (CI: 2.33-3.74); poverty level 200-399%(OR= 1.73 (CI: 1.37-2.20); child's health care caused financial problems (OR= 1.42 (CI: 1.19-1.70); and family needed more money because of child's condition (OR= 1.90 (CI: 1.60-2.27). Discussion will address the use of the national survey as a methodological tool for health care planning, the need to assess the emotional health of CSHCN, linkages to quality treatment and services – especially mental health services, and policies to prevent discontinuous health coverage.

Learning Objectives:
1. Describe a profile of U.S. children with special health care needs who are at-risk for discontinuous health insurance coverage. 2. Discuss the benefits of a website for analyzing a population-based dataset, the 2005/06 National Survey of Children with Special Health Care Needs, for community health planning and policy development.

Keywords: Children With Special Needs, Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Since completing a doctorate in public health in 1993, I have analyzed previous population-based datasets pertaining to children's health, presented peer-reviewed abstracts at national and international conferences, and published in major peer-review journals. My dissertation consisted of a prevalence study of chronic conditions among a random sample of low-income children enrolled in a special insurance program established by Blue Cross of Western Pennsylvania (prior to SCHIP) and an evaluation of care coordination to a select group of children with special health care needs enrolled in the insurance program. I am currently a full-time, tenure track faculty member at Florida State University where I developed and teach two on-line graduate level courses: Applied Statistics and Nursing Research.
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.

See more of: Maintaining Health Insurance Coverage for Vulnerable Children
See more of: Community Health Planning and Policy Development