Inequities in health care needs for children with medical complexity

Abstract

Children with special health care needs are believed to be susceptible to inequities in health and health care access. Within the group with special needs, there is a smaller group of children with medical complexity: children who require medical services beyond what is typically required by children with special health care needs. We describe health care inequities for the children with medical complexity compared to children with special health care needs but without medical complexity, based on a secondary analysis of data from the 2005-06 and 2009-10 National Survey of Children with Special Health Care Needs. The survey examines the prevalence, health care service use, and needs of children and youth with special care needs, as reported by their families. The inequities we examined were those based on race/ethnicity, primary language in the household, insurance type, and poverty status. We found that children with medical complexity were twice as likely to have at least one unmet need, compared to children without medical complexity. Among the children with medical complexity, unmet need was not associated with primary language, income level, or having Medicaid. We conclude that medical complexity itself can be a primary determinant of unmet needs.

Keywords: Children’s Health; Chronic Care; Disparities; Maternal And Child Health.

Exhibit 3. Incidence Rate Ratios Comparing The Number Of Unmet Needs, By Determinants Of Health Care Inequity For Children Without Medical Complexity

SOURCE Authors' analysis of data from the 2005–06 and 2009–10 National Survey of Children with Special Health Care Needs. NOTES The reference groups are the following: for race or ethnicity, non-Hispanic white; for primary language, English; for income (as percentage of the federal poverty level), 400 percent or more; for insurance, private. The whiskers denote 95% confidence intervals. An incidence rate ratio of 1 would indicate the same number of unmet needs that the reference group had. A ratio of greater than 1 indicates more unmet needs than the reference group had, and a ratio of less than 1 indicates fewer unmet needs.

Exhibit 4. Incidence Rate Ratios Comparing The Number Of Unmet Needs, By Determinants Of Health Care Inequity For Children With Medical Complexity

SOURCE Authors' analysis of data from the 2005–06 and 2009–10 National Survey of Children with Special Health Care Needs. NOTES The reference groups are the following: for race or ethnicity, non-Hispanic white; for primary language, English; for income (as percentage of the federal poverty level), 400 percent or more; for insurance, private. The whiskers denote 95% confidence intervals. For a description of incidence rate ratios, see the Notes to Exhibit 3.