Financial Burden in Families of Children With Special Health Care Needs: Variability Among States

George Warren Brown School of Social Work, Washington University, Campus Box 1196, St Louis, MO 63130-4899, USA.
PEDIATRICS (Impact Factor: 5.47). 08/2008; 122(1):13-8. DOI: 10.1542/peds.2006-3308
Source: PubMed


The main objective of this study was to examine variability among states for 3 indicators of the family financial burden related to caring for children with special health care needs.
Data were from a 2001 national survey of households with children (<18 years of age) with special health care needs, with a representative sample from each state. The outcomes examined included whether a family had any out-of-pocket expenditures during the previous 12 months related to the child's special health care needs, the amount of expenditure (absolute burden), and the amount of expenditure per $1000 of family income (relative burden). We used multilevel regression to examine state-level variability in financial burden, controlling for individual-level factors. We also examined the association between state median family income and state mean financial burden.
Overall, 82.5% of families reported expenditures of more than $0. Among these families, the mean unadjusted absolute burden was $752 and the relative burden was $19.6 per $1000. Adjusted state means ranged from $562 to $972 for absolute burden and from $14.5 to $32.3 per $1000 for relative burden. Families living in states with higher median family incomes had lower financial burdens across all 3 measures.
Families that are similar with respect to household demographic characteristics and the nature of their children's special health care needs have different out-of-pocket health expenditures depending on the state in which they live. Documenting and understanding this variability moves the field closer to the goal of establishing evidence-based, state policy recommendations aimed at reducing the financial burden of these vulnerable families.

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Available from: Susan Parish, Aug 31, 2015
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    • "Contribution to the Literature While the literature has identified financial burden as an area of concern among families of children with chronic conditions and activity limitations, certain substantive and methodological issues potentially limit the generalizability and accuracy of prior studies. First, most research has examined the financial burden associated with OOP healthcare expenditures specific to the child or the family, but not both (Banthin and Bernard 2006; Galbraith et al. 2005; Houtrow et al. 2008; Hwang et al. 2001; Newacheck 2005; Newacheck et al. 2004; Shattuck and Parish 2008). Given that parents of children with limitations are vulnerable to deleterious spillover effects on their health and mental health (Sen and Yurtsever 2007; Silver et al. 1998, 1999; Waddington and Busch-Rossnagel 1992; Witt and DeLeire 2009), there is potential for increased healthcare use and expenditures not only for the child but also for other family members (Altman et al. 1999). "
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    ABSTRACT: This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996-2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0-17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p<0.05), and were 54% more likely to experience relative burden (p<0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.
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    • "Health care expenditures require the family to have adequate monetary resources to meet these fiscal demands. When there are inadequate financial resources, families may perceive a burden (Davidoff, 2004;Kuhlthau et al, 2005;Shattuck & Parish, 2008;Skinner & Slifkin, 2007;Yu et al., 2008). In addition as expenditures increase, requiring greater financial resources, burden may also increase. "
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    ABSTRACT: We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child's health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs.
    Full-text · Article · Feb 2010 · Journal of Child and Family Studies
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    • "For these families, crowding-out may provide important and well-targeted social benefits (e.g. Shattuck and Parish, 2008). Obviously, for the marginal crowded-out family, SCHIP does not reduce uninsurance. "
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    ABSTRACT: Objective: To assess the effects of Medicaid and SCHIP-related crowd-out on out-of-pocket medical expenditures and family premium costs for affected families. Data Sources: Data are drawn from the 2001 and 2004 panels of the Survey of Income and Program Participation (SIPP), administered by the U.S. Census Bureau. We construct a nationally representative, longitudinal sample of children, ages 0-18, and their families for the period 2001-2005. Study Design: We hypothesize that child health status is a determinate of crowd-out, and that crowd-out should reduce out-of-pocket and family premium costs. We first estimate the extent of crowd out for 2001-2005. Next we operationalize a definition of crowd-out that exploits the SIPP's longitudinal design. We use this in a bootstrapped instrumental variable approach to estimate the effects of crowd-out on out-of-pocket and premium costs. Principal Findings: Estimates suggest there was substantial crowd-out during 2001-2005. Families who crowd out appear relatively vulnerable, and child health status appears highly predictive of crowd-out. Crowd-out appears to provide a cash-equivalent transfer of approximately $2,500 annually for families in the form of reduced out-of- pocket and premium costs. Conclusions: Contrary to current public policy debates that often assume crowd-out represents a societal cost, our results suggest that it may bring important social benefits to vulnerable families.
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