Disparities and inequities between children with special health care needs with and without disabilities

Objective: Children with disabilities are among the most vulnerable members of society. Understanding the experiences of these children can help inform policies to improve health outcomes. The objective of this study was to compare CSHCN with and without disabilities in terms of their health and health care experiences. Methods: Secondary data analysis was performed using the National Survey of CSHCN, 2005-06. CSHCN with disabilities were identified using the Screener which asked if the child had an ongoing limitation in their ability to do the things that other children of the same age can do. We stratified CSHCN by disability status for comparison purposes. Statistics were calculated using STATA. Results: 2.2 million CSHCN have disabilities. Blacks, Hispanics, publicly insured children, children living in poverty, and children raised by single parents are disproportionally affected by disability. The health conditions of CSHCN with disabilities compared to other CSHCN were more commonly deemed severe (26% vs. 4%), and unstable (16% vs. 4%). CSHCN with disabilities had higher rates of health care utilization and unmet need compared to other CSHCN. Less than 1/3 of CSHCN with disabilities received care in a medical home compared to over 50% of other CSHCN. Discussion: This survey identifies some important disparities and inequities among CSHCN. CSHCN with disabilities have poorer health, higher utilization and need, and have more difficulty accessing services including care within a medical home. Health policies should assure that the needs of this population are met because these children are most at risk for negative consequences.