Delayed and Forgone Care for Children with Special Health Care Needs in Virginia: A Cross-Sectional Study using 2005-2006 NS-CSHCN
Nevena Skoro
Objectives: The objectives of the study were to: 1) summarize illness characteristics and functional ability difficulties among Children With Special Health Care Needs (CSHCN) in Virginia, 2) examine the distribution of socio-demographic, health insurance, and health-related factors among Virginia�s CSHCN, 3) quantify the influence of these factors on delayed and forgone care of CSHNC in Virginia, and 4) analyze reasons for delayed/forgone care among Virginia's CSHCN.
Methods: Data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) were used. Three categories of predictor variables were studied: socio-demographic, health insurance, and illness variables. Outcome variable was whether a child experienced delayed/forgone care. We explored the relationship between predictor variables and outcome variable using bivariate and multivariable logistic regression analyses. Analyses were adjusted for the complex survey design using SAS 9.1.
Results: Our data included 791 study samples, which represents 289,176 CSHCN from Virginia. Approximately 6.1% of CSHCN in Virginia experienced delayed or forgone health care in the past 12 months. Multivariable analysis showed that family structure and insurance characteristics were significant predictors of delayed and forgone care. CSHCN who did not live in two-parent household were 2.7 times (95% CI [1.05, 7.31]) more likely to experience delayed/forgone care compared to children who live in two-parent household. CSHCN who were ever uninsured during the past 12 months were 17 times (95% CI [3.85, 75.58]) more likely to experience delayed/forgone care compared to children who were continuously insured. CSHCN who had inadequate insurance were 5.8 times (95% CI [2.06, 16.37]) more likely to experience delayed/forgone care, compared to children with adequate insurance. CSHCN who did not have a usual source of health care were 22.6 times (95% CI [2.83, 180.55]) more likely to experience delayed/forgone health care, compared to children with usual source of health care.
Conclusion: Policies and programs that address health insurance coverage and continuity, that increase the number of children with medical homes and usual sources of health care, and that address the needs of families that are particularly vulnerable should be implemented.
