title: Access to health care for children with special health care needs.
abstract: OBJECTIVE
  To assess the role health insurance plays in influencing access to care and use of services by children with special health care needs.
  
  
  METHODS
  We analyzed data on 57 553 children younger than 18 years old included in the 1994-1995 National Health Interview Survey on Disability. The survey obtained information on special health care needs, insurance status, and access to and use of health services. Bivariate and multivariate analyses were used to assess the association of insurance with several measures of access and utilization, including usual source of care, site of usual care, missed or delayed care, and use of ambulatory physician services.
  
  
  RESULTS
  Using the federal Maternal and Child Health Bureau definition of children with special health care needs, we estimate that 18% of US children under 18 years old had an existing special health care need in 1994-1995. An estimated 89% of these children had some form of health insurance coverage, most often private health insurance. Insured children were more likely than uninsured children to have a usual source of care (96.9% vs 79.2%). Among those with a usual source of care, insured children were more likely than uninsured children to have an identified regular clinician (87. 6% vs 80.7%). Insured children were less likely to report unmet health needs, including medical care (2.2% vs 10.5%), dental care (6. 1% vs 23.9%), prescriptions, and/or eyeglasses (3.1% vs 12.3%), and mental health care (.9% vs 3.4%). Insured children were also more likely to have a physician contact in the past year (89.3% vs 73.6%) and have more physician contacts on an annual basis (8.5 vs 4.1 contacts). Unexpectedly, no differences were found between insured and uninsured children in availability of after hours medical care (evenings and weekends) or satisfaction with care. We also found some modest differences in access between publicly and privately insured children. Privately insured children were more likely to have a usual source of care (97.6% vs 95.3%) and a regular clinician (91.0% vs 81.1%). Privately insured children were also less likely to report dissatisfaction with care at their usual site of care (14. 9% vs 21.0%) and have access to care on evenings and weekends (6.8% vs 13.4%). No substantial differences were found between privately and publicly insured children in prevalence of unmet health needs or delays in obtaining care due to cost.
  
  
  CONCLUSIONS
  This study illustrates the importance of health insurance for children with special health care needs. Continued efforts are needed to ensure that all children with special health care needs have insurance and that remaining access and utilization barriers for currently insured children with special health care needs are also addressed.
authors.affiliation: Institute for Health Policy Studies, San Francisco, CA 94118, USA. pauln@itsa.ucsf.edu
authors.forename: P W
authors.initials: PW
authors.lastname: Newacheck
authors.forename: M
authors.initials: M
authors.lastname: McManus
authors.forename: H B
authors.initials: HB
authors.lastname: Fox
authors.forename: Y Y
authors.initials: YY
authors.lastname: Hung
authors.forename: N
authors.initials: N
authors.lastname: Halfon
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D019988:Children with Disabilities; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D017057:Medically Uninsured; D014481:United States