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Delayed and forgone care for children with special health care needs in New York State
Arlene Smaldone1, Judy Honig, Mary W Byrne
1Behavioral and Mental Health Research Section, Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA. arlene.smaldone@joslin.harvard.edu
Insights
In New York, over 40,000 children with special health care needs (CSHCN) experienced delayed or forgone routine care. Key barriers include inconsistent insurance and poor provider communication, impacting access to essential healthcare services.
Area of Science:
- Pediatric Health Services Research
- Health Disparities
- Healthcare Access and Quality
Background:
- Children with special health care needs (CSHCN) often face unique challenges in accessing timely and appropriate medical services.
- Parental reports are crucial for understanding care barriers experienced by CSHCN.
- Previous research indicates that insurance status and provider interactions significantly influence healthcare access.
Purpose of the Study:
- To identify key characteristics associated with delayed or forgone routine healthcare for CSHCN in New York State (NYS).
- To analyze parental reports on barriers to care for CSHCN.
- To inform strategies for improving healthcare access for this vulnerable population.
Main Methods:
- Utilized data from NYS participants in the 2000-2002 National Survey of Children with Special Health Care Needs.
- Employed weighted bivariate and multivariate regression models to analyze the relationship between independent variables and delayed/forgone routine care.
- Independent variables included illness characteristics, insurance status, and provider care attributes.
Main Results:
- 8.4% of CSHCN in NYS experienced delayed or forgone routine healthcare.
- Uninsured status (aOR 3.8), interrupted insurance (aOR 3.9), and inadequate insurance (aOR 3.6) were significantly associated with delayed care.
- Poor provider communication, including inadequate time (aOR 6.3), insufficient information (aOR 8.0), lack of partnership (aOR 6.7), and cultural insensitivity (aOR 5.4), were also strong predictors.
Conclusions:
- Approximately 40,771 CSHCN in NYS faced delayed or forgone routine healthcare.
- Inadequate/discontinuous insurance coverage and poor provider-family communication are critical barriers.
- Improving consistent insurance and enhancing provider sensitivity are vital for better CSHCN access to care.
Objective:
To identify characteristics associated with delayed/forgone care for children with special health care needs (CSHCN) in New York State (NYS) as reported by their parents.
Methods:
Data come from NYS participants in the 2000-2002 National Survey of Children with Special Health Care Needs. Data were analyzed using weighted bivariate and multivariate regression models. The dependent variable was report of delayed/forgone routine health care. Independent variables included illness characteristics, potential and actual access to care, and provider care characteristics.
Results:
In NYS, 8.4% reported delayed/forgone health care for their child. Parents of children with delayed/forgone care were more likely to report that their child was uninsured (adjusted odds ratio [aOR] 3.8, 95% confidence interval [CI] 1.3-11.8), had experienced interrupted health insurance (aOR 3.9, 95% CI 1.5-9.7), or their child's insurance was not adequate for CSHCN (aOR 3.6, 95% CI 1.4-9.1). Further, these parents were more likely to report that providers never spend adequate time (aOR 6.3, 95% CI 1.2-34.4), provide sufficient information (aOR 8.0, 95% CI 2.5-25.0), act as partners in care (aOR 6.7, 95% CI 2.3-19.7), or display cultural sensitivity (aOR 5.4, 95% CI 1.2-24.3).
Conclusions:
An estimated 40,771 NYS CSHCN experience delayed/forgone routine health care. Their families report two noteworthy barriers: inadequate or discontinuous insurance coverage and poor communication with health-care providers. Access to care for CSHCN can be improved by increasing consistent comprehensive insurance coverage and increasing sensitivity in relationships between health care providers and families of CSHCN.
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