State and national estimates of insurance coverage and health care utilization for adolescents with chronic conditions from the National Survey of Children's Health, 2003.
ABSTRACT To examine health and insurance characteristics of adolescents with special health care needs (ASHCN), at state and federal levels.
We used the National Survey of Children's Health 2003, a nationally representative sample of children in the United States, to study adolescents 14-17 years of age. We present descriptive statistics and regression analyses of adolescents with and without special health care needs, regarding measures of health care use and insurance coverage.
Approximately 22% of adolescents 14-17 years old have a special health care need. On average, ASHCN have one more annual office visit per year than their non-SHCN peers (p < .001). ASHCN report three times the rate of unmet medical needs compared to their non-SHCN peers (p < .001), despite higher rates of insurance coverage (94% vs. 88%, p < .001). Overall, 26.9% of ASHCN have public coverage. Nationally, more than half of those ASHCN with public coverage report incomes above 100% of the federal poverty level (FPL), which puts them at risk for losing coverage when they age into adulthood. Across states, proportions of ASHCN on public coverage and with incomes > 100% FPL range from 3.2% to 37.5%.
One in six ASHCN currently has public coverage with household income that would make them ineligible by income criteria for continuing public coverage as adults. It is imperative to examine insurance continuity and corresponding health outcomes for ASHCN as they transition from child to adult health care settings, and to evaluate options for policy interventions that can sustain health care coverage for this vulnerable population.
SourceAvailable from: Kristine Piescher
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ABSTRACT: Publicly financed insurance programs are tasked with maintaining coverage for eligible children, but published measures to assess coverage have not been evaluated. Therefore, we sought to identify and categorize measures of health insurance continuity for children and adolescents. We conducted a systematic review of Medline and HealthStar databases, review of reference lists of eligible articles, and contact with experts. We categorized measures into 8 domains based on a conceptual framework. We identified 147 measures from 84 eligible articles. Most measures evaluated the following domains: always insured (41%), repeatedly uninsured (36%), and transition out of coverage (29%), while fewer assessed single gap in coverage, always uninsured, transition into coverage, change in coverage, and eligibility. Only 18% of measures assessed associations between continuity of coverage and child and adolescent health outcomes. These results suggest that a number of measures of continuity of coverage exist, but few measures have assessed impact on outcomes.Medical Care Research and Review 11/2013; 71(2). DOI:10.1177/1077558713504245 · 2.57 Impact Factor
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ABSTRACT: Objectives. We compared estimates for children with and without special health care needs (SHCN) at 2 time periods for national health objectives related to the Healthy People 2010 leading health indicators (LHIs). Methods. Data were from the 2003 and 2007 National Surveys of Children's Health. Seven survey items were relevant to the LHIs and available in both survey years: physical activity, obesity, household tobacco use, current insurance, personal health care provider, past-month depressive symptoms, and past-year emergency department visits. Results. In 2003 and 2007, children with SHCN fared worse than those without SHCN with respect to physical activity, obesity, household tobacco exposure, depressive symptomology, and emergency department visits, but fared better on current insurance and having a personal health care provider. Physical activity and access to a personal health care provider increased for all children, whereas the absolute disparity in personal provider access decreased 4.9%. Conclusions. Significant disparities exist for key population health indicators between children with and without SHCN. Analyses illustrated how population-based initiatives could be used to frame health challenges among vulnerable populations. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e8. doi:10.2105/AJPH.2012.301001).American Journal of Public Health 04/2013; 103(6). DOI:10.2105/AJPH.2012.301001 · 4.23 Impact Factor