Health Insurance and Children with Disabilities

Division of General Pediatrics, University of Rochester School of Medicine and Dentistry, USA.
The Future of Children (Impact Factor: 1.98). 03/2012; 22(1):123-48. DOI: 10.2307/41475649
Source: PubMed


Few people would disagree that children with disabilities need adequate health insurance. But what kind of health insurance coverage would be optimal for these children? Peter Szilagyi surveys the current state of insurance coverage for children with special health care needs and examines critical aspects of coverage with an eye to helping policy makers and clinicians improve systems of care for them. He also reviews the extent to which insurance enhances their access to and use of health care, the quality of care received, and their health outcomes.
Szilagyi begins by noting that nearly 9 percent of children with disabilities are uninsured for all or part of a year and that coverage even for many such children with insurance is inadequate—either not meeting their needs or not adequately covering the costs of care. By one estimate, nearly two of every five special needs children are either uninsured or inadequately insured.
The author finds strong evidence that health insurance improves access to health care. Children with disabilities who are insured are more likely than those who are uninsured to have a primary care provider, to be able to reach a specialist, and to have access to supporting services. They also have fewer unmet needs for medical and oral health care and receive care more quickly. The bulk of the evidence shows that insurance improves quality of care for children in general and for children with disabilities. Parents of insured children with chronic conditions are more satisfied with their children's primary care, medications, specialty care, and overall health care than are parents of their uninsured peers. A handful of studies of specific diseases have found insurance to be related to improvements in quality measures, such as more doctor visits and greater continuity of care.
In conclusion, Szilagyi stresses the need to provide adequate health insurance to all children with disabilities and to develop a set of best practices in health insurance to cover important services needed by this population. To that end, implementation of the federal health care reform act, including the mandate for insurance coverage, is important. He also urges support for medical home and other quality initiatives and better ways to monitor quality and health outcomes to ensure that children with disabilities receive cost-effective and equitable care.

Full-text preview

Available from:
  • Source
    • "caring for their child (Burton & Phipps 2009, Carter et al. 2012, Galbraith et al. 2005, Houtrow et al. 2008, Szilagyi 2012, Woodgate et al. 2012). Prior to having a FSW, many parents in our study were totally dependent on public transport; this was often a logistical nightmare involving the challenge of safely getting the 'sick' child, all their equipment on and off buses or into taxis and to the destination on time. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Children with life-limiting and disabling conditions are surviving longer than previously, and many require palliative and supportive care, usually at home. Home-based care can put family life under considerable strain, as parents care for their child's complex, often unpredictable, continuing care needs. Rainbow Trust Children's Charity aims to bridge gaps in services for children with life-threatening or terminal conditions by providing family support workers (FSWs). The study used a range of methods (surveys, interviews and ethnographic observation) approach to explore key aspects of the work of the FSWs. The target population for the surveys was families with a child having complex, life-threatening or terminal conditions receiving care from FSWs. The participants included 55 families (12 bereaved) and 39 children aged 2-18 years. Thematic analysis revealed how the FSWs became a presence in families' lives in three main ways: (1) encompassing and embracing families through supporting needs and promoting resilience; (2) befriending and bonding through developing knowledge, trusting relationships and a sense of closeness; and (3) accompanying and enduring by 'being with' families in different settings, situations and crises and by enduring alongside the families. The study demonstrated the fundamental importance of workers who are able to provide aspects of support that is usually not provided by other services.
    Full-text · Article · Jan 2014 · Journal of Child Health Care
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Technological innovation is transforming the prevalence and functional impact of child disability, the scale of social disparities in child disability, and perhaps the essential meaning of disability in an increasingly technology-dominated world. In this article, Paul Wise investigates several specific facets of this transformation. He begins by showing how technological change influences the definition of disability, noting that all technology attempts to address some deficiency in human capacity or in the human condition.
    Preview · Article · Jan 2012 · The Future of Children
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Much attention has aided measurement and improvement in the quality of health care during the past two decades, with new ways to define and measure quality, recognition that doing so can identify strategies to enhance care, and systematic efforts by both government and private insurers to apply these principles. In this article, James Perrin reviews these gains. Although children have benefited, these quality measurement efforts have focused mainly on adult health care. Now, two recent federal programs promise to expand quality measurement of child health care.
    Preview · Article · Mar 2012 · The Future of Children
Show more