Impact of Health Care Related Financial Burden on Unmet Need among Children with Special Health Care Needs

Families of children with special health care needs (CSHCN) are particularly vulnerable to experiencing elevated financial burden as a result of high health care utilization. We sought to determine how subjective and objective health care related financial burden are related to delayed or forgone care for CSHCN, using a nationally representative, population-based sample. We examined data on 36,187 CSHCN from the 2005-2006 National Survey of Children with Special Health Care Needs. Subjective financial burden was defined by self-report that the reference child's health care caused financial problems for their family. Objective, absolute financial burden was defined as the reported amount the family paid for the reference child's health care over the past 12 months. Objective, relative financial burden was defined as self-report of needing any additional income to cover the reference child's health care expenses. Delayed or forgone care was defined as self-report of delayed or forgone needed health care for the reference child during the past 12 months. Experiencing subjective financial burden (OR 1.93, 95% CI: 1.74-2.15) and objective relative financial burden (OR 1.90, 95% CI: 1.70-2.12) were both independently associated with increased odds of experiencing delayed or forgone care, adjusting for other relevant sociodemographic characteristics. Subjective and objective, relative financial burden are both strong, independent predictors of delayed or forgone care for CSHCN. To prevent unmet need for this vulnerable population, policy changes targeted at alleviating relative burden, such as implementing income adjusted cost-sharing, may be more effective than policies that address absolute burden.