260982 Underinsurance in children with special health care needs: The impact of definition on findings

Wednesday, October 31, 2012

Julie Preskitt, MSOT, MPH, PhD , School of Public Health - Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL
Beverly A. Mulvihill, PhD , School of Public Health - Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL
Rene McEldowney, PhD , Department of Political Science, Auburn University, Auburn University, AL
Nir Menachemi, PhD , School of Public Health - Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL
Background: Having insurance that adequately meets health needs is a critical, but complex issue for children with special health care needs (CSHCN). Clearly defining underinsurance is vital for policymakers to fully and accurately characterize the problem. Our objectives are to identify differences in who is considered underinsured when identified by two commonly-used definitions and to discuss implications for policy decisions based on using one definition over the other.

Methods Data from the National Survey of CSHCN, 2005/06 were analyzed; only continuously-insured CSHCN were included. We identified underinsured cohorts using "economic" and "attitudinal" definitions, examining CSHCN identified by each definition, by both, and by one but not the other. Variables included demographics and condition/health characteristics.

Results Different underinsurance rates were identified [attitudinal=30.9% (n=11,470); economic=22.7% (n=8,447); both=12.6% (n=4,693); attitudinal only=19.1% (n=6,777); economic only=10.1% (n=3,754)] with only fair agreement by kappa score (0.3194; Z=65.91; p>0.0001). Differences across cohorts included family income ≥400% FPL (attitudinal only=34.2%, economic only=16.3%, both=18.4%; p<0.001) and high condition severity (attitudinal only=42.5%, economic only=68.5%, both=69.9%; p<0.001). CSHCN needing equipment, medical supplies, or home health had increased likelihood of being underinsurance by the economic definition only (1.31, p<0.01).

Conclusions: Choosing either definition excludes some potentially underinsured CSHCN, thus underestimating underinsurance. Despite overlap between definitions, there is variation in identification and among characteristics associated with the odds of being underinsured. A definition that comprehensively identifies and describes underinsurance is vital to translating health coverage expansion into benefit packages that meet complex health and service needs. Further research should focus on definition development.

Learning Areas:
Public health or related public policy
Public health or related research

Learning Objectives:
1. Compare identfication of and factors associated with underinsurance in children with special health care needs based upon two different definitions. 2. Discuss implications for policy decisions and conclusions based upon selecting one definition over another.

Keywords: Children With Special Needs, Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This is based on original work I conducted as a part of my dissertation during my doctoral program. Also, I have worked in adminstration of a State Title V CSHCN Program. I am now MCH faculty in a school of public health and children with special health care needs, underinsurance, and access to care are my areas of expertise.
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.

Back to: 5024.0: MCH International Health and Children with Special Health Care Needs Poster Session